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Posts Tagged ‘Childhood obesity

Re-designing: opportunity to reframe problems and solution
Excellent read
Note: I consider this article as an extended version of how Human Factors engineers and practitioners must approach problems and experiments, and focusing on the health, safety and ease of use of any product or service.

The wider determinants of health developed by Public Health England show that in fact, things like someone’s education, their job, who their friends are, how they get on with family, and where they live can actually determine how long they will live – even if they’re using the same doctor as someone living down the road but who is likely to live 10 years longer.

In the last two decades, design has been demonstrating a refreshing approach to addressing such complex problems. This is because design provides the opportunity to re-frame problems and solutions.

It explores ways of doing things that haven’t been tried before, to address problems that haven’t been well understood before.

But in this age of complexity and multiple dependencies, problems are constantly and rapidly changing too, and so must solutions. We need to move away from the romantic notion that a solution – whether it’s a service, product or policy – needs to go through a one-off and well-polished design process, beyond which it will continue to be relevant forevermore.

Reality is very different.

So we’re making the case here that as designers, we have a mission to build the capabilities of non-designers who work within the organisations that are transforming our future.

This means they are equipped with the problem-solving mindset to constantly interrogate, improve and innovate as realities quickly evolve, and things that worked yesterday soon become obsolete.

Urgency for prevention and early intervention: There is a sense of urgency to pre-empt problems before they happen in order to save time, resource and often even lives.

The recent NHS Sustainability and Transformation Partnerships (STPs) demonstrate this urgency. With an ever-increasing population, public services are at breaking point. (It has already broken down)

But since two-thirds of deaths among those under 75 are a result of preventable illness, there is a growing recognition that keeping as many people as possible healthy is the most sustainable investment.

This is where a lot of the STP plans are focusing their energy. Because design offers a lens into the future and a provocation for possible realities, it provides those committed to prevention and early intervention with the ability to understand future problems and to design solutions that can forestall them.

Systemic complexity: We can no longer think of products, services and policies outside of the systems they exist within and interact with.

For example, we worked with the Healthy London Partnership on a deep dive to understand the root causes of childhood obesity and to try out new ways of addressing this chronic challenge.

Our insight revealed that a one-pronged approach will never do.

We need to create positive and synchronised triggers at different points in the system: we need behavioural nudges that change the habits of individuals, we need social movements that influence and inspire whole communities, we need levers that transform physical obesogenic environments, and we also need legislation and regulation such as the Sugary Drink Tax to reduce temptation.

Design invites diverse people across the system to confront problems collaboratively, by creating solutions that leverage the collective power of everyone’s experience, expertise, resource and authority.

Ongoing transformation: In a time of austerity, we just can’t afford to keep slowly chipping away at the problem through little tweaks and tricks in the hope that it will one day disappear. We need to completely and continuously re-imagine how things might work better.

When working with a national charity, we realised that funding for children’s centres was at risk, and that they were struggling to reach diverse families. This meant we needed to completely transform the service, into one where children’s centres can go (literally ‘in a box’) into the homes of those who most need them, for a ninth of the cost and nine times the reach.

A design approach to problem-solving offered staff the opportunity to experiment with transformational ideas at a small and safe scale, fail quickly, learn fast and build confidence in the direction of travel.

What capabilities

Organisations need to develop a number of problem-solving capabilities to future-proof their solutions. In a recent Touchpoint article, my colleagues Jocelyn Bailey and Cat Drew argue that these capabilities are presumably less about skill and more about mindset and culture. Armed with the right mindset, organisations can then develop (and even invent) the unique skills, methods and tools to solve all types of diverse problems. This mindset is characterised by:

Deep human understandingthe approach invites curiosity and determination to explore what lies beneath people’s actions, decisions and perceptions.

Reframing challengesthe insight revealed through deep human understanding can help reframe the challenge to get to the bottom of the hidden root causes, rather than the visible symptoms.

Working with othersa design approach to problem-solving is humble. We admit that we don’t know it all, and we invite others who have experienced the problem in different ways or who are experts in related issues across the system, to come on board and shape the journey.

Learning by doingthe only way to test innovation is to give it a go. Design is a process of solving problems through doing, learning, improving and scaling. Starting small and imperfect can mitigate the risks of failure, and with every iterative cycle and every improved version, more investment and scale can be justified.


There are various ways that organisations can build the problem-solving capabilities of their workforce. Last year, I wrote an article with Joyce Yee in the Service Design Impact Report that reviewed different design capability models that the public sector draws on. There is not a one-size-fits-all model, and each presents its own benefits:

Structured trainingthis varies from one-day workshops to bootcamps. These are best for beginners who would like a taster of the mindset to assess whether it provides potential for the nature of their organisation’s challenges.

Experiential learningin other words, learning on the job. Often this takes the form of design experts facilitating a series of problem-solving sprints within an organisation, based on a real challenge. Staff are invited to shadow the process, reflect on learning, and experience the benefits first-hand.

Coachingthis model is suited for more experienced organisations who have potentially benefited from structured training and/or experiential learning. They would be keen to lead the problem-solving process themselves, with the support of a design coach for strategic guidance, alignment, and constructive provocation.

Internal disruption: a popular example of this is the lab model, where an organisation invests in an innovation team embedded within, with a role to create and grow a movement and a culture that embraces a design mindset to problem-solving.

In today’s complex and rapidly evolving world, organisations need to start thinking differently about how they are future-proofing what they do and how they do it. They need to invest in people, not solutions. By better equipping their people with a problem-solving mindset, they are creating the enablers for ongoing improvement, innovation and future relevance.


Joanna is Design Director at Uscreates. She is a social designer, author, speaker and lecturer with over 15 years of practical experience in the UK, the Middle East and the United States. She leads on the development and delivery of service design, user centred innovation, design research, business modelling, communication and digital design projects.

Joanna has worked with over 50 public and third sector organisations – including Nesta, The Healthy London Partnership, the Health Foundation and South London and Maudsley NHS Foundation Trust – to help them better understand and address their challenges.

She has expertise across a broad range of social challenges including health and wellbeing, social integration, social action, employment, education and social enterprise. Joanna has a Ph.D. in design for social integration in design for social integration and is an RSA fellow. She is an associate lecturer at the University of the Arts London, Kingston University and Ravensbourne University.


City life-style: fattening, infertile, blinding, depressive…

Should cities carry a health warning?

A growing body of research shows that babies born in cities, and children who grow up in them, face a battery of health problems that afflict both their physical and mental well-being.

The problems pose a serious threat because ever-increasing numbers of us are spending our lives in cities.

JOHN NAISH updated his post on Nov. 21, 2011

Why living in a city makes you fat, infertile, blind, depressed and even causes cancer

The picture of happiness? Urban living is associated with higher risk of chronic health disorders, such as mental illness, immune diseases, arthritis, heart disease, cancer and fertility problems

Is this a picture of happiness?

Urban living is associated with higher risk of chronic health disorders, such as mental illness, immune diseases, arthritis, heart disease, cancer and fertility problems

In 1900, only 14% of the world’s population were city-dwellers. Three years ago, that figure had risen to 50%.

By 2050, the United Nations predict that 70% of people will be urbanized.

City-dwellers should be expected to have a better deal in life, compared with their rural counterparts.

On average, city-dwellers are wealthier and have better job prospects. They enjoy bountiful food, superior healthcare and cleaner sanitation.

But urban living carries a significantly increased risk of chronic health disorders, such as mental illness, immune diseases, arthritis, heart disease, cancer and fertility problems.

City life: Studies have found that pre-natal daily exposure to urban pollution can set us up for a lifetime of ill-health

City life: Studies have found that pre-natal daily exposure to urban pollution can set us up for a lifetime of ill-health

And as cities become ever more crowded, these problems are only going to get worse.

The latest studies indicate that daily exposure to urban pollution can affect us before we are even born — leaving us prone to a lifetime of ill-health.

Scientists have discovered that babies born in cities are bigger and heavier — normally a good sign — than those born in the countryside. But when they compared the placentas of mothers from a busy city and a quiet rural district, they found that the city mums had far higher levels of chemical pollutants called xenoestrogens in their blood — and in that of their unborn babies.

Xenoestrogens are industrial chemicals that affect our bodies in similar ways to the female hormone, oestrogen.

They are found in countless man-made pollutants such as petrol fumes, and are more abundant in industrial areas than the countryside.

As well as causing excess foetal growth, they have been linked to problems such as obesity, hyperactivity, early puberty, fertility problems and cancers of the lung, breast and prostate.

The researchers, from the University of Granada and Spain, found that although city mothers were older and weighed less than rural mothers, they still gave birth to larger babies.

Dr Maria Marcos, who led the study, says the toxic xenoestrogens seem to have a significant effect on the development of unborn children. Her report provides the latest evidence that city air can seriously hinder normal childhood development.

Tired and tested: Complete exhaustion is said to be a complaint caused by city life

Tired and tested: Complete exhaustion is said to be a complaint caused by city life

It doesn’t end there.

Last year, laboratory tests undertaken at the Ohio State University showed how urban pollutants may cause metabolic changes in toddlers that result in raised blood sugar levels and increased resistance to insulin — which regulates the way our bodies metabolize carbohydrates.

The university’s professor of environmental health science, Dr Qinghua Sun, has observed that these pollutants can lead to the development of Type 2 diabetes.

‘These fine chemical particles directly cause inflammation and changes in fat cells, both of which increase the risk of Type 2 diabetes. In cities, it would be very difficult to escape the pervasive influence of dirty air that begins early in life.’

Indeed, growing numbers of children never leave their city environment.

Figures from the pressure group Farming And Countryside Education indicate that one in 5 British youngsters has never visited the countryside. A further 17%  had only been ‘once or twice’.

Worse still for children’s development, city upbringings normally entail indoor lifestyles. Modern, concrete city-scapes are so unfriendly that only 20% of youngsters play in the streets, yet 70%  of adults can recall doing so when they were children.

Growing up indoors has its own health threats — not least to growing eyes.

Children who spend most of their day indoors have a far greater chance of suffering from ‘high myopia’, a severe form of short-sightedness. Half of sufferers become blind by middle-age.

Researchers at Australia’s Centre of Excellence in Vision Science believe that lack of sunlight is the culprit. They say exposure to sunshine causes the retina to release dopamine, a hormone that inhibits the excessive eyeball growth that causes myopia.

Their studies have found that children who spend time outdoors cut their risk of short-sightedness by a fifth.

City childhoods have also been blamed for the fact that urban youngsters are more likely than their rural counterparts to develop asthma and other allergies.

The theory — called the ‘hygiene hypothesis’ — suggests city children do not get to play in the mud, lie on the grass or splash in puddles and are therefore deprived of early exposure to relatively harmless microbes in the soil.

Fun? Young people who are brought up in cities can experience significant levels of stress. This makes them more likely to have schizophrenia and other anxiety disorders

Fun? Young people who are brought up in cities can experience significant levels of stress. This makes them more likely to have schizophrenia and other anxiety disorders

Instead, they grow up in over-hygienic homes — wiped down with antibacterial cleaning products and vacuumed religiously — that deny their immature immune systems the opportunity to develop a normal resistance to germs.

Recent research has indicated that city-dwelling mothers can even pass over-sensitive allergic reactions to their babies in the womb.

A study in the Journal of Experimental Medicine found that mothers who live amid farmyard microbes give birth to allergy-resistant offspring. This does not happen with mothers in cities.

Perhaps most disturbing is the toll on young minds that can be wrought by the stress of growing up in urban areas.

According to the hygiene hypothesis, because city children don’t play in the mud, they are more likely to develop asthma and allergies

A study by Dr Glyn Lewis, of the Institute of Psychiatry in London, shows that incidence of schizophrenia is twice as high in men who are born and brought up in cities.

People in cities also have a 39%  higher risk of mood problems such as depression and bipolar disorder, and a 21%  increased risk of anxiety disorders — such as panic attacks, extreme phobias and obsessive-compulsiveness.

Young women growing up in cities are 5 times more likely to suffer from the eating disorder bulimia, according to a 10-year study in the British Journal of Psychiatry.

Earlier this year, German researchers reported that the brains of people born in cities actually operate differently from those in rural areas.

The study, based on brain scans, found that two regions of the brain, the amygdala and the cingulate cortex (both involved in regulation of emotion and anxiety), became overactive in city-dwellers when confronted with stress triggers.

The reaction in participants from the countryside was much milder.

Professor Andreas Meyer-Lindenberg, of the University of Heidelberg, says: ‘We know what the amygdala does — it is the danger-sensor of the brain and is therefore linked to anxiety and depression.

‘The cingulate cortex is important for controlling emotion and dealing with environmental adversity.’

He goes on to say that this excess activity could be caused by growing up amid environmental stress, and may lie at the root of many mental health problems.

Urban over-crowding may be a significant cause of these problems. Meyer-Lindenberg adds: ‘If someone invades your personal space, the amygdala-cingulate circuit gets switched on, so the trouble could be something as simple as urban density.’

Childhood obesity is a major problem in cities

Childhood obesity is a major problem in cities

Packed public transport, busy pavements and heaving High Street shops are all culprits.

And urban upbringings may be contributing to the rapid rise of behavioural problems in children, particularly attention deficit hyperactivity disorder (ADHD).

American studies in the journal Archives of General Psychiatry have found a link between city childhoods and poor attention spans.

You don’t need to be a scientist to show how there is something about the countryside that soothes the human brain.

But one theory — called biophilia — is that over millennial of evolution, humans have developed a natural affinity for green surroundings, and we become anxious when deprived of them.

Research by Frances Kuo, an Illinois University environmental psychologist, supports this.

She runs a project studying hyperactive children who are brought out of the city to spend time enjoying the countryside.

She claims that just a 20-minute walk in the open air can yield a substantial improvement in a child’s attention-span.

The benefit of this short walk is equals the effects of taking Ritalin — the controversial behavioural drug often prescribed to children with ADHD.

However, most urbanites are too busy to seek out nature’s therapeutic influence.

The Government’s UK 2000 Time Use Survey shows that out of the 1,440 minutes each day, the average Briton spends only one minute in the countryside or at the seaside or even in a park or garden.

Not only should we slap a health warning on urban life — we should put a regular spell in the countryside on prescription.

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March 2023

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