* Stefano Maffei, teaches Advanced Product-Service System and Production Models, Service Design and Theories and Cultures of Innovation at the Design School of the Politecnico di Milano. He is the directors of the Polifactory, the Politecnico makers' space.
Health is important.
But we realize this only when we are threatened. It is not only about individual basic health, for which we are the only regulators in an eternal face-off with our paternalistic State.
We are talking about the importance of public health. Which is made of an infinite series of rules, decisions, actions, processes, technologies, artifacts, which we usually do not notice.
The emergency has had an impact, transforming our everyday life and acting to magnify the details of every little part of the system: making us think about the essence of our existence and projecting it into a dystopian light.
We see that our individual health depends on medicine. But the idea of health is more than the simple concept of an objective to be reached, i.e. the destruction of the illness. Health is not just eliminating harm; it is also about living in a healthy way. Which means feeling good, caring for ourselves and others. Therefore, health is never an individual act, but one that requires the presence of others, and a relationship.
“…I will protect you from the fears of hypochondria
The troubling thoughts you will meet along the way, from now on
The injustices and deceptions of your time
The failures that by your nature you normally attract…”
This social dimension of care is at the basis of any objective idea of wellbeing, but it is also what we have neglected in recent years.
It is easy to realize this if we read La Cura, the story-experiment of Oriana Persico and Salvatore Iaconesi. The latter, diagnosed with a brain tumor in 2012, decided together with his partner to approach the illness and its cure in an open, collective way: publishing his clinical condition online and giving everyone the possibility of observing its course. In what then became a book, the two write that “no cure exists if not in the society.”
The cure (and the care) is, in short, more than just medicine. “People are healthier and bounce back faster from illness if they feel they are part of something bigger. When they satisfy their needs for health, not just in clinical terms. This means having positive relationships and being part of a community in which people share experiences and support each other.”
At the center of these reflections there is a change of models of welfare. Or perhaps the imagination of a future anthropocentric but not positivist, progressive welfare. Capable of responding to the global challenges of climate change, the need for a new green deal, inclusive distribution of wealth and possibilities of access to education, work and rights.
Public health is also the acid test of this process that cannot be bonded with technological progress in a linear way: “With the increasing inequalities of healthcare, life expectancy and the number of people that live with long-term conditions of physical and mental health, we have waited for some time for a change in the investments on research, with a more experimental, participatory approach. Only 5% of health research investment goes into prevention. This tells us a lot about the scope of the problem, but little about its solutions.”
We have to redesign the care system, including something that the technocratic government of health has expelled: us.
Therefore the new processes of innovation of care will have to include increasingly strong representation of the interests, needs and values of us citizens, the principle users of the models we experience every day. Mission-oriented innovation, in this case, means opening the greater system of care to the collaboration of various forms of expertise, of visions and resources (and their ecosystems of stakeholders).
Hence these are open processes of innovation, from the bottom up, based on listening to needs, participation and co-design of processes of care that cannot be left only in the hands of policymakers or business. And a participation that widens the field to include patients and caregivers, utilizing patient innovation as a factor complementary to technology.
Nesta, the thinktank financed by the English government (there are not only Brexiters in the UK) has recently worked on the theme of the future of health research. And it has imagined a visionary project, The Nightingale. This is a new center of research and innovation on excellence (named for Florence Nightingale) for the development of social, behavioral and environmental models for improvement of public health. What is it supposed to do? “To cut across disciplines (e.g. public health, research, social sciences, data, design and community development) to reflect the multifaceted nature of public health challenges and the impact of local context and experience. To operate on an intensive R&D model that creates evidence-based solutions at pace, using a combination of creative ideas, practical experimentation and rigorous evaluation which goes beyond research alone.” And to receive “a budget of £140 million per year by 2025.”
Less technical commissions composed only of experts, who only make rules for us.
What is needed now, therefore, is more vision and a more transdisciplinary, future-oriented and speculative approach. But one that is ready to be quickly and effectively prototyped, with the right resources, with open, collaborative minds.
The project for the future: a Ministry of Care, designing and iconoclast, that knows how to develop our most precious common resource: our public health.
Cover photo: Iye, installation by media artist e sound designer Pim Boreel dedicated to the physical vulnerability of human beings, Embassy of Health, Ducht Design Week Eindhoven, 17-25 October 2020. Ph. Jaap Beyleveld.