The Program is Not Enough: Public Health’s Innovation Evolution

“The traditional public health campaign to change behavior in communities is broken,” said Andre Blackman to the crowded room. “There might be a celebrity partnership; There’s usually a catchy phrase that took a long time to come up with, even though it sounds hollow and out of context. A few months after the campaign launch, you see those posters peeling off the sides of the bus stops and billboards. And barely anything has actually changed.”

Thus began the Onboard Health x CommonHealth ACTION mixer last week in Washington DC, an intimate, invite-only discussion forum for the next generation of public health thinkers, dreamers, and doers. Mr. Blackman — he goes by Andre — is the founder of Onboard Health, a workforce platform for professionals seeking jobs that matter today at companies with an innovative, strategic vision for the health of tomorrow.

Don’t mistake his remarks for cynicism; he was couching them in realism and experience, drawn from a career spent nudging public health forward, projectby project. While we can all agree the status quo is failing, and that we’ve got key deficits in funding and data, the energy that bubbled throughout the evening came from the long-term optimism on the most under-appreciated resource in public health: People.

Leaping the gap

Onboard’s thesis is a simple one at heart. Injecting a new generation of talent into the staid, often antiquated world of public health is not just a good idea — it’s the strategic roadmap into the future of the field. Public Health doesn’t just need innovation and leadership — it needs innovators and leaders. The difference is subtle, but critical.

Public Health has lived in the lab for too long, studying problems rather than fixing them. Most of the ‘interventions’ tend to be designed with a published paper in mind, rather than as a solution built for the real world.

As one CEO put it during Onboard’s career mixer at GWU last fall: “[In public health research] it’s easy to wind up shopping around for the right community to study. But people are smart, and they’ll figure out that you’re not there to solve their problem — you’re there to solve your problem.”

This existential fallacy — studying problems as they persist and deteriorate — has traditionally been accepted as just another part of the work, a moral hazard of the profession. At some point, it even got its own innocuous moniker: “the research to practice gap.” But instead of trying to fill this widening gap with programs, posters, and reams of published studies, the mixer encouraged a simpler approach: train people to build bridges — or where possible, leap over the gap altogether.

It’s no coincidence that this happens to be the overarching mission of CommonHealth ACTION, who co-sponsored and hosted the event in their Dupont Circle digs. Led by President and CEO Natalie Burke, they’re a non-profit dedicated to improving leadership and addressing systemic workplace issues that hold back organizations, teams, and people from reaching their full potential for impact. Ms. Burke forged her career in DC navigating the intersection of policy, advocacy, and leadership; her passion for authentic relationships and sustainable equity was evident in her opening remarks.

We enjoyed engaging conversations with several of the staff — a smart, passionate team, mostly women of color. Janelle Thomas, joined the organization after career stints as a healthcare consultant, cancer reform advocate, housing official, and public health advisor in the City of Baltimore. We immediately asked her how played out it is, on a scale of one to ten, to bring up “The Wire” when someone says they’re from Baltimore. She told us it was an 11 — but that honestly, the show does capture the tensions of urban public health.

We talked about the show’s third season, when a rogue police major decriminalizes drugs in an attempt to slow crime rates, and public health researchers swarm into ‘Hamsterdam’ with clean needles and condoms, clipboards waving. She shared glimpses of her experiences working with the types of youth and families that inspired the show, as well as some of her frustration with the limitations of public health departments.

“The program is not enough!” she insisted, questioning the absence of ongoing engagement with communities in most public health programs around the country. Yes, this is the result of a lack of department level funding, she pointed out, but so too is it the result of limited vision, creativity and ultimately leadership within these departments. The same holds true for other organizations in the space, from universities to foundations, not to mention hospitals and health plans.

Incorporating innovation & technology

To borrow a maxim from Tony Robbins, oftentimes failure is not driven by a lack of resources, but by a lack resourcefulness. It’s high time public health started paying attention to the principles of innovation and disruption that have gripped other industries by the throat: Healthcare continues to rob the GDP while failing our most vulnerable citizens and many others, too, with a UX that’s so retrograde and clunky that it actively keeps people from engaging. It’s time to fight back.

The world around us is changing, fast. Posters and programs won’t cut it in a world where everything we experience as consumers is the result of meticulous, well-funded engagement hacking, from digital advertising to design thinking, built to get us to click, buy, and eat what they want. Isn’t it past due to bring a page of this playbook into public health?

A key ingredient, for example, in digital health startup Omada’s secret sauce was borrowing some of the sticky design elements of Instagram to bend their entire approach around their users’ whims and tendencies. CEO Sean Duffy points to their avoidance of ‘the single instrument fallacy’ as perhaps the main principle behind their successful approach. In the last six months, Amazon has developed Medicaid discounts while Google has quietly funded health plans and primary care clinics targeting the underserved. Change is a comin’.

The unrealized potential of diversity and inclusion

Source: Interaction Institute for Social Change

As healthcare expands its view from pure clinical care towards addressing the social determinants of health, the most important gear in the thought process has become clear: equity. The difference between equality and equity seems tiny, but when designing tools and policies, it translates to a magnitude of order, as visualized brilliantly in the New York Times (worth a click!)

Source: New York Times — but seriously, watch the animated version

With persistent disparities in access and outcomes for lower income families, blacks, Latinos, LGBT, and other minority groups, it’s time to ask why there hasn’t been more representative leadership in industry or policy. Ms. Burke used this as a backdrop to talk about CommonHealth ACTION’s spring Equity, Diversity, and Inclusion Training Institute, a crash course training session the likes of which could gently nudge corporate America in the right direction.

It got me thinking. A week before this event, I attended a conference and heard a brilliant talk by Judith Davis, a VP in charge of social determinants-related programs at BCBS of Illinois. She spoke tactically about the key role that electronic referral tools play in capturing SDOH data and building a longer-term business case for subsequent investment, before shifting gears to share their approach to faith-based outreach work in Chicago, in partnership with churches, street teams, and communities.

Later that night over dinner, I told my fiancée (who happens to be a diversity and inclusion consultant) how I’d been inspired by how this big-company executive was so fluidly versed in tech innovation as well as community impact. I live in this world, I told her, and those topics are still mostly separate. She pointed out that it would be interesting to run a study of those social innovations in corporate healthcare settings, to see how often a person of color tends to be at the helm.

While I’d agreed with her at the time, I realize that attending the mixer has made me shift gears a little bit. It would make an interesting study — but does healthcare need another study? What if we skipped the middle step and just got more of the right people into the right jobs?

Up Next: More of the Different

“We’re truly excited about the brilliant, diverse professionals in DC and beyond who want to get plugged into learning & career opportunities to build their body of work for sustainable health impact. This is why we’re here.” — Andre Blackman

DC has a bad rap for being homogeneous town of bureacrats, but the room suggested otherwise. A common theme throughout the evening was the array of hats that everyone had worn through their careers. This was a room of folks who had cycled between the worlds of consulting, advocacy, care delivery, government, academia, and entrepreneurship — and the conversations reflected it.

We heard people celebrating progressive trendsetters like Lyft, whose recent business forays into healthcare resemble strategic decisions by the likes of Amazon, Google, and Apple. There were wonky discussions about social impact bonds and Medicaid waivers, sandwiched around blunt stories about affirmative action and nightmare bosses at county health departments of yore. The absence of code-switching, the passion for candid discussion, and the hunger for ideas left us invigorated as we trickled out the doors.

So even though the short-term, program-level thinking endemic to public health has constituted a single instrument fallacy of its own, it’s all set to change. The headlines and tea-leaves all point forward, to a future chapter of public health innovation that’s determined by the people who build it. The next generation of leaders, cross-pollinators, and visionaries has already rolled up their sleeves.


Naveen Rao is Managing Partner at Patchwise Labs.