Monday, August 29, 2011

In defense of innovation

I'm currently reading this excellent book by Gerald M. Weinberg called Becoming a Technical Leader: An organic problem-solving approach. This, along with some recent class experiences, has prompted me to start thinking about the real place that innovation has in the public health care realm.

Public health, unlike computer science and other technical disciplines, is unlikely to be revolutionized by that next great idea; a single spark is unlikely to ignite a flame. That attribute, however, doesn't prevent public health from the need for great and innovative ideas. Ideas that were not forged in a sterile academic test environment ... no, those ideas are inadequate. What we need in this field, what our populace deserves, is a thinking and creative workforce that creates new approaches to old problems.

I was troubled today by a response I received from a teacher during class. I quoted the 1998 book Public Health and Marketing, which asserts that public health practitioners need to adopt strategies and mindsets that exist in the marketing realm. Specifically, we are encouraged to realize that corporate marketing professionals only expect a 2-3% per annum change in purchasing behavior (note the "per annum"). In other words, public health professionals need to set more realistic expectations for mass behavior change. This seems reasonable to me, as someone who does a lot of independent research, because I have yet to see sufficient evidence that behavior change can be achieved through educational efforts.

I was thoroughly trounced, albeit politely, by my professor, who essentially laughed at me, telling me that any proposal that promised a 2-3% change per annum would be swiftly rejected for its inefficiency. Let me bring up the following points, though. For example, in a 5-year program, assuming a 3% change annually, one could effectively change at least 15% of the target market. Perhaps a 2-3% change is warranted because of the characteristics of the health problem; if we're changing 2-3% of the rates of homicide in the U.S., for example, we might have an argument for the program if it's low-cost and efficient. Furthermore, those affected by the change may have the ability to influence their community, effectively changing social norms.

There must be something wrong with me because I have the continuous faith that professors, fellow students, and the public as a whole are as optimistic and revolutionary as I choose to be. Yes, I do my public health research. I read books upon books that have nothing to do with class, but everything to do with actual implementation of public health principles.

Take, for example, the remarkable book Theory in Health Promotion Research and Practice: Thinking outside the box, by Texas A&M's own Patricia Goodson. I won't go into detail about the book (since I'm honestly not done reading it), but the title alone should make us stop and question our motives in this field. Thinking outside the box. Theory does have its applicability, and evidence-based public health practice is important, but our field must also be receptive to the radical and weird ideas that just might change the world.

Why are we stumbling around within our profession when so many questions have been answered by research in other disciplines? We have a problem with our marketing strategy ... why don't we look at marketing research to fix the problem? There's a reason that the big corporations are dwarfing our public health efforts ... they have the resources to hire the best and the smartest campaign development staff. Our field seems to be sinking in stagnation and self-congratulatory angst. I'm kind of not impressed.

I am compelled by Weinberg's leadership model, which calls upon technical leaders to motivate, organize, and innovate. The overall theme of the book calls upon those who have been innovators in the past to stimulate new ideas by creating motivation and organization that supports new ideas.

As a leader in this field (which I hope to be one day), I can only say that I would be remiss if I didn't entertain some wacky approaches to public health; after all, we really have no idea what works in this field, so how can we trust the evidence we have? Goodson says that it's rather insane to think that we can imagine ourselves capable of predicting others' behavior. "Well, I raised his self-efficacy, so there must have been an improvement," we say, without understanding what those catch phrases really mean.

The point of this post, I suppose, is to request that public health academicians step down off their beautiful high pedestals and come join the rest of us in the real world, where things are messy and difficult to define. Allow us to think radically. Allow us to feel empowered to go out into the world and make changes! I don't want to work within the crappy existing framework that public health requires, and by golly, I don't have to.

I want to think critically about problems using a variety of perspectives, and I intend to apply theory from *gasp* other disciplines such as engineering, economics, manufacturing technology, and management. Get it together, folks. Public health is the ultimate conglomeration, the meeting place for all courses of study, and all should be recognized as valid. Who cares if it's theoretically supported if it works?!

Maybe I'm just a starry-eyed optimist, but so are others who really make a difference.

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