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Changing the landscape of health

By Dave Snowden  ·  November 30, 2013  ·  Diabetes, Managing Complex Systems, Innovation

My last two posts discussed by personal journey, and one which is not yet complete.  I'll update that from time to time, especially when I close in on my target weight of 82 kg which I should make when I start the 60@60 Round Wales Walk this February.  I now want to move on to look at some of the work we are doing in this sector.  As I said in my first post my getting diabetes was ironic as it was one of the areas we had selected to look at in connection with a wealth of new offerings using SenseMaker® for health and well being.  I need to be circumspect here as some of the ideas need to be in the patent process before we talk about them in any detail.  I've learnt to my cost this last year that even some long standing network members (and ones we de facto subsidised on revenue and cash) cannot be trusted, so I am being more cautious than I like.  Anyone who wants more get in touch and with a NDA we can talk.

It is worth a quick refresh on two of the key principles of complexity (or rather cognitive complexity as we need to look at human complex systems in a very different way from those in termites nests).  

  1. To manage a complex system we need to changes the dispositions of populations and small level social interactions.  People are fundamentally influenced by the micro narratives of their day to day lives, rather than grand narratives of change and admonishment.  
  2. In order to manage any behaviour in a complex system fast feedback loops are key.  Just to get personal again I have two apps that record my exercise and calorie intake every day and that allows me to manage my behaviour and take corrective action.  But we want more than that, we want proximity to solutions that would resonate with our own narratives rather than some idealised one.

So what are our plans?  They start with journalling; getting people to create a narrative record of how they are feeling, what they are doing/encountering on a fragmented, as it happens basis.   We can also capture stories and other artefacts at specific points in a journey - a visit to the doctor for example.  To give an illustration, staying in a Travelodge near London City Airport a few weeks ago I would have take a picture of the menu and signified it in a negative way.  The weather was foul, I was ill and needed to eat but there was nothing on the menu that was safe for a diabetic (or anyone trying to loose weight for that matter).  At the same time when I realised that a belt I could not use three months ago as it didn't have enough notches was now too large and would have to be abandoned, that was a small story of progress. I might also record some of the comments from people I have not seen for months and so on.

The idea here is that people at risk would be encouraged to keep such a diary and in some cases it could be incentivised.  Insurance companies will already reduce premiums based on monitoring driving behaviour so agreeing to keep a health diary when you pass thirty and move into a different risk bracket should not be too difficult.  We are also planning school projects on health that would indirectly influence behaviour.  Children on an oral history project for their school on health and well being are great citizen journalists, but also learn and influence as a result.  As I know to my cost there is nothing worse than a nagging daughter ....

Critically because SenseMaker® empowers the respondent to interpret their own story we are gathering longitudinal quantitative data which has utility for the individual as well as researchers and health care workers.  In the latter case there is no longer a need to depend on reported experience in a consultation as the real time data is already there.   I can already give my dietician access to my calorie counting app so she can check weekly and advise rather than rely in my reporting behaviour after the event in a consultation.   But even when we meet the full record is more useful for both us than my recall.  We can also set up prompts to get people to tell a story at fixed points during the day.

We have already shown on other medical projects that this human metadata can account for some of the variations on more conventional medical data, as we also showed in military environments.  Real time mass quantitative human data can explain things that conventional sensors and scanning cannot.  With time-stamping and geolocation so it can be linked to medical data for research purposes (suitably anonymised).

Recording real time data for feedback to professionals has value in its own right and a utility for the individual, but now we can go beyond that.   We are moving here to the point where people can look at other stories like theres over defined timelines and find stories that match or contradict their own.  This appeals to human curiosity, but also allows for the type of serendipitous learning that is key to human discovery and sense-making It means that someone like me, if I had started this twenty years ago would have encountered similar stories told my someone at the same age, but who is now thirty years on in the cycle and loosing their site or suffering amputation.   That is more likely to modify my behaviour that any lecture by a professional, or at least will mean I listen to said lecture with more attention.  We will also be building links to connect diets, therapies and the like fragments to fragments to allow for contextual discovery of novel and sustainable solutions.    

In a few weeks time I am sitting down with Ann Pendleton-Jullian who is key to this project to work on ways in which the same system can trigger alerts based on those stories to reduce the risk of symptoms of heart failure going unreported until it is too late.  This builds on our original weak signal detection work in counter terrorism, and its a very similar problem.  Quantitatively self-interpreted material provides a sophisticated anticipatory monitor that can be used by the individual, their family and careers especially in remove areas.

A wider goal is to create a series of progressive steps that someone can take, in which each step is characterised by more stories like this, fewer stories like that that allow for self monitoring and progressive measures,  It allows a journey to be small steps on a landscape but  I can choose the easiest gradient, or I can choose a hard step.   I did that by choosing to take a drastic diet change in the first months which got me to a level where I could maintain it with more ease, but not everyone would want to do that, or have the opportunity for that matter.

All of this is about prevention, but it is also about people and process.  Creating self correcting systems that shift problem solving to a much earlier stage in the life cycle.   I was passionate about this before I contracted diabetes, but now its personal