Today is World Health Day! The 7th of April 2023 marks the 75th anniversary of the World Health Organisation since its founding in 1948. 

The theme for 2023 is “Health for All”

It is a chance for the Cynefin Centre Health and Care Programme team to reflect on what health means to us and how we hope to shape the world going forward. This blog post explores the boundary of Health and Care – from healthcare professional and patient settings all the way to the effects of inequality, global debts, and climate change. The evidence is too hard to ignore: investment in health not only improves our day to day wellbeing but has knock on effects on labour, economic, and educational productivity (Jamison et al., 2013). Similarly, investment in economic productivity, equality, and climate change has a positive effect on health (Tinson, Major & Finch, 2022). Never before has there been a greater need to expand the boundary of health and care, and invest in all its spheres, to truly ensure health for all. 

Some populations are young and growing, others are older or shrinking, technology use in healthcare is expanding, and comorbidities are increasing (World Economic Forum, 2019). The milieu for health professionals and clinical settings is under pressure to adapt to our changing populations. Not to mention the COVID-19 pandemic that exposed and exacerbated pressure on health workers, hospitals, and care facilities all over the world (Kaye et al., 2021). Chronic healthcare professional understaffing, poor retention, insufficient funding, and long patient waiting times are just some of the situations we have found ourselves in today that affect our ability to provide healthcare to all (British Medical Association, 2022)

It is useful to also reflect on how health affects and is affected by, factors beyond clinical healthcare settings. For example, greater income inequality in a society is significantly correlated with a host of other mental and physical health problems. In England, men in the most deprived areas are expected to live almost 10 years less, and women almost 8 years less, than those in the wealthiest areas – with those in the most deprived areas living 19 fewer years in good health (Gregory, 2022). Prof Richard Wilkinson, a British social epidemiologist, outlined how societies with greater inequality also often have weakened social cohesion which affects how people protect and uplift others – with worsening health effects for all (Wilkinson, 2002).

“Increased inequality imposes a psychological burden which reduces the wellbeing of the whole society.” (Wilkinson, 2002) 

Debt Justice, a UK based company campaigning to restructure and end global debt, argues that the negative health effects of inequality are not just within countries, but also between countries. For example, despite the Ukraine government experiencing excessive pressure to provide food and medicine to its citizens, it is still having to pay upwards of $7 billion of its national budget to lenders (Phelps, 2022). Due to high interest rates, it was estimated that in 2021, one in five low- and middle-income countries were paying more money to debt repayments than health, education, and social protection sectors combined (International Development Alliance, 2022).

The Health Foundation, an independent health charity in the UK, similarly outlined the link between inequality, reduced economic activity, and health – with increasing ill-health leading to decreased labour and decreased economic growth (Tinson, Major & Finch, 2022). In addition, they are sounding the alarm about the links between health and climate change – both requiring a long-term, prevention approach that spans across government departments and society groups on a global scale.

“The complex systems of determinants and impacts of health and climate change are interconnected, and climate change is adversely harming human health, through both direct and indirect impacts.” (Marshall & Allen, 2023) 

Health and care encompasses almost all systems and processes around us, and only with this in mind, can we truly work towards health for all.

Happy #WorldHealthDay, everyone.

P.S. We need evidence to make informed decisions. Gapminder is an independent foundation that aims to help us gather global statistics and present them in an understandable way. I’d highly recommend taking their misconceptions quiz and watch their video on how the world is faring in the Sustainable Development Goals. Spoiler alert, these goals are highly connected and require collaborative approaches.

And for evidence when it comes to complexity? There is of course always Cynefin Co!

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Banner image my own, a chance to show off my home town, Cape Town. In-text image courtesy of WHO campaign page.

On September 16, 2019, Cognitive Edge was invited to a Research Meeting convened by the Stanford Center for Design Research and the David Ramsey Map Center. In this session, I joined our longtime friend and partner, Ade Mabogunje from the Standard D-school and his colleague, Salim Mohd, the Head of the Rumsey Center together with 15 different experts. The event was convened to integrate perspectives on Innovation Ecosystem and Design Thinking to come together to share insights. 

“The concept for the meeting was a synergy of five realizations. First, from research done by Malte Jung et al. we know that the creative design process depends on two critical actions – perceiving and acting, and two critical objects – a context, and a purpose. Second, to paraphrase the research of Barbara Tversky, spatial thinking is the foundation of thought and, from moving in the world, humans construct spatial maps in the brain which supports maps of time, of social relations, of ideas, and of values.  Third, technology innovations require the confluence of these same constructs viz place, time, design teams, scientific ideas, and human values expressed in terms of proxies such as needs and problems, rewards and risks, credits and debits. Fourth, the David Rumsey Map Center has the facility to prototype and test a variety of ways in which a set of researchers and practitioners can be convened and supported while nurturing the growth of mission-focused start-up ventures and organizations in an ecosystem. Fifth, given the coming challenges of global climate change, there will be a strong need to design, develop, deploy, and test the effectiveness of many such prototypes in the near future. This meeting provided us the opportunity to create and test an early prototype.” [1]

The Dave Rumsey Map Center is a revelation and an amazing place to be contemplating the narrative landscapes and cultural topography that Cognitive Edge was invited to talk about. The Center has put together an introductory video which toys with all the 15 perspectives in what we have playfully named “A Thought Experiment”. Our collective perspectives share a common perspective that shifting into more organic, natural frameworks of thinking are critical to deal with increasing complexity and uncertainty in our lives. 

Back in Sept 2019, we were all still blissfully unaware of the COVID-19 virus that would soon be disrupting all our lives. The video and presentations have just been released and looking back now, we are further convinced of the need to incorporate this ecosystem approach into how we design our systems. 

#becausehumans

[1] Stanford Libraries. Innovation Ecosystem and Design Thinking – Visualization Research Meeting. https://library.stanford.edu/rumsey/events/recorded-talks/innovation-ecosystem-and-design-thinking-visualization-research-meeting Accessed 22 June 2020

Photo by Deborah Diem on Unsplash

I have been thinking a lot about climate change during the COVID-19 times (and so have many many many others). Two things have struck many among us, and have repeatedly been brought up in discussions I have been a part of. The first main theme has been “nature returning”: clearer skies, cleaner waters (or in the case of Venice probably less silt being stirred up, but still), animals claiming their place in quieter streets. Here in Cyprus, I sometimes find myself missing the lockdown curfew: I could see owls gliding past my balcony then. The change seems immediate and considerable. The second theme has been the clear impression that citizens, governments, businesses, and pretty much any agent you can name are prepared to make radical changes in the face of radical and immediate threats. The relative scarcity of such changes (from all of us) in the face of climate change, suggests that we do not actually, truly, believe it is a radical and immediate threat, and those few who do (or who see it every day and are experiencing the consequences already) are lone voices shouting in the desert.

And now this has happened: a new virus has come, and the whole landscape around us has shifted. If COVID-19 and the lockdowns are an ongoing earthquake, then new paths have opened and we can now cross what used to be impassable mountains. Turns out a lot of the travel wasn’t really necessary (which shouldn’t come as a surprise to most of us). Turns out a lot of the lovely places of the world we are destroying bit by bit through our touristic presence would be much better off without us and that tourism is not a sustainable basis for an economy. Turns out there are lots of things wrong with the bases and assumptions of our economy (this REALLY should come as no surprise). And many of us have rediscovered the pleasures of home, and reading, and family. Now, none of these things is new, and just like with climate change people have been shouting them for ages. What is new is the number of people that have suddenly and vividly been made aware of them. In this changed and changing landscape, with its new rifts, valleys, and mountain peaks, we can do new things.

So I do not think there is a better time for me to return to some of the concerns Dave brought up last year, through what I have come to call the Acorn Study: action and inaction and the bases behind it, small actions and the shifts they cause, sideways approaches to the enormous monster of climate change. At the beginning of the year, when COVID-19 was still something most of us were ignoring because it was the problem of others far away (sounds at all familiar?), I and Ellie Snowden started working on compiling bibliography for the impact of small actions and the causes of inaction around climate change. This lead to a comprehensive whitepaper that is to become the background of the next phase of our climate journey: a series of approaches from different angles that are all meant to explore the routes, crags, and hidden paths of this new landscape, so we can all better find our way, available to organisations to use. 

You can can read it HERE, or email us if you want more information, want to apply parts of it, or want to work with us and others in developing additional approaches. 

HERE you can find a much shorter and lighter outline of our newly-launched fledgling programme.

I want to close with an extensive quote from Robert Macfarlane’s Underland, a book I read recently and that inspired the illustration for this post:

Cognitive Edge, through the Cynefin Centre, is part of an exciting project team funded by a United States National Science Foundation grant. This project focuses on the rebuilding of Puerto Rico after Hurricane Maria and provides us with an opportunity to collaborate on the real-time decisions being made around the reconstruction.

We will focus on bringing the transdisciplinary human element and complexity thinking to a fascinating mix of disciplines, ranging from hydrological, electrical and mechanical engineering, meteorology, climatology, and social ecology to data science and social science. The 3-year project will focus on understanding the impact of the interdependencies of critical infrastructure systems, such as the power and water networks, when exposed to weather extremes, and how those interdependencies cause failures of physical assets, leading to dramatic impacts on the health and socio-economic wellbeing of communities in those regions.

Zhen Goh, from Cognitive Edge, in discussion at the project workshop.

The first field trip to visit the site was held in mid-January 2019. The University of Puerto Rico Mayaguez, our local partner, hosted a week-long engagement where we were given the opportunity to hear from local government and local community leaders. It was also an important session for the different disciplines to discuss the development of a truly interdisciplinary definition of resilience. The development of a white paper to contemplate how an integrated definition of Resilience looks through multiple disciplinary lenses is now underway. SenseMaker® is being deployed to collect narrative input on how citizens and institutions experienced Maria.

SenseMaker® will also be utilised at a later stage in the research to provide decision augmentation around new recommendations that come out of our research. This grant falls under the Critical Resilient Interdependent Infrastructure Systems and Processes (CRISP 2.0) arm, with an aim to “Enhance the Resilience of Islanded Communities”. Working through our partner, New York University, this is a three-year grant with an interdisciplinary mix of academics from New York University, City College New York, Arizona State University, University of Puerto Rico, Brookhaven Laboratories and Sandia National Laboratories.

Check out the project website at http://eric21.org

Read more about this project (in Spanish): RUM en millonario proyecto de la NSF para resiliencia de la isla

Contact us if you are interested to learn more about our work, and how we could partner with you.

Photo credits: https://www.uprm.edu/portada/2019/01/18/rum-en-millonario-proyecto-de-la-nsf-para-resiliencia-de-la-isla/

It's been an interesting few days in Paris with an eclectic group of various academics covering a range of topics.  I've had a chance to meet and talk with Paul Thagard whose work on coherence I have used extensively.  Then of course there are old friends such as Alicia Juarrero and Mike Lissak and a lot of new ideas and concepts from new contacts.   Tim Allen's presentation this morning on Hierarchy Theory gave me a break through idea on monitoring and evaluation which I need to do some more work on.  To wet any appetites out there we need to put a double loop process into SenseMaker® projects but I need to translate terms such as Bounded infinite and The Finite allowed first.   I also need to think through some of the practical implications but I'm very excited.  It also overcomes some of the naiveté of those who attempt to hide behind post-modernist absolutism (please note the qualification).

I've always argued for Praxis, the interaction of theory and practice, ideally the co-evolution of the two.  Interestingly this is not just that, its also exaptation, taking an idea from Biology and applying it to social systems.  The process of creation is always messy.  You have an idea, you try it out, you refine practice, more problems emerge.  Then you find some interesting people to talk to, books and papers to read and from that you get clarity or better problem definition.  Then some more changes and so on.  The point at which you realise you have got there is when both theory and practice are elegant.  That was taught me early on in Physics at University, namely that an elegance counts in maths.

Of course elegance requires simplicity, but that takes time to achieve.  The simplistic never understand that.  Interestingly they don't seem to understand disagreement or challenge either.  The last few days have seen some rigorous discussion over probably irreconcilable differences.  But we have all learnt from that and valued the learning.  Those who can't cope with that are condemned to ignorance, although there were probably happy to remain where they started, ignorance after all is held to be bliss.

Oh, and I also spent a lot on books and SenseMaker® got a great reception as a research and meaning-making tool

The feather original evolved for regulation of temperature, but then evolved for flight.  In 1942 a scientist at Raytheon was testing a magnetron, a key component of radar, and noticed that a candy bar melted in his pocket.  The next day he experimented with a egg which burst and spattered hot yolk over his face; thus was the microwave oven was born.  Scientists at Pfizer’s Sandwich research establishment (I was within 24 hours of working there during my IBM days but that is a story for another day) were able to synthesise the compound Sildenafil which has then formulated to treat hypertension angina pectoris on which it had little effect, but the test on men in Morriston Hospital in Swansea produced an interesting side effect that resulted in the best selling blue pill, Viagra.  I might as a loyal supporter of Cardiff suggest that this was probably the most exciting thing to happen in the history of Swansea, but given that the performance of the Cardiff Blues has been the antithesis of that of the Welsh team in recent weeks I think I had better avoid such tribal banter.  All three of these are examples of exaptation or serendipitous innovation which is the subject of this long delayed post.

Speaking of tribal matters, it has been a long two weeks since Wales won the Grand Slam, to the point where it only today in Singapore that I got round to wearing the T Shirt, printed in confidence by the WRU before the game and sold as we left.  Within 24 hours of that victory I was on the road again to Singapore via Durham and Hong Kong with a transit in Helsinki. An interesting bit of branding there by the way, by T-shirt does not show the score of the final game, while the ones on sale now do.  So I have proof “I was there”.  Between a packed schedule of meetings, a weekend in a hospitality box at the 7s and eight hours jet lag I have barely had time to think let along write, but finally a long weekend allows me to catch up, and hopefully I will be back to near daily blogging again from tomorrow, my birthday as it happens.

So, pleasantries over lets get on to the main business, the fascinating subject of exaptation; its also a very practical subject as its at the heart of innovation and resilience in organisations.

Now the last time I attended a conference on this subject it was on the shores of Lake Garda and Peter Allen (who presented before me) was staying in Mussolini’s former bedroom at the University of Milan’s conference centre (pictured) which is slightly more salubrious than Durham’s Business School where email access is only allowed via the web and hot showers between midnight and 0600 are not permitted.  However the intellectual content was as, if not more fascinating, in part because I have spent a lot of my reading time around this subject and other aspects of the fusion of anthropology and biology, which to me is one of the most fascinating aspects of trans-disciplinary studies at the moment. The event included biologists, anthropologists, economists, modellers, neuro-scientists and the like.  I was the only person there who was not a full time academic which was flattering and I am grateful to Pierpallo Andriani for the invitation.

Now these sort of free form mixed events are rare, and even rarer is a to fund such a group who are not precious about their particular discipline so it was with reluctance that I left at lunch time on day one to make the train to Manchester Airport and thence to Helsinki.  I kept notes of the first day and a half and along with the reaction to my own presentation (on how to manage the pre-conditions for exaptation referencing our work with SenseMaker®) made it a valuable learning event including a lot of new ideas our new advanced Cynefin course.  More of that in future posts.  For the moment I want to share my notes, future posts will develop the ideas.

So for those not familiar with the term exaptation, lets start with a couple of definitions (these from Gould & Verba 1982 borrowing from Bob Layton’s presentation):

An exaptation is a trait evolved/designed for other uses, and later “co-opted” for its current role.

An adaptation is designed specifically for the task it performs, or ‘built’ by natural selection for the function it now performs.

Now weather exaptation is evident in biology rather depends on which definition you take.  But the real heart of this is a debate between adaptationists and exaptationists which has major implications for our understanding of ourselves and for the organisations of which we are a part.  I should own up not to the fact that I am firmly in the latter of these two camps.  Adaptationists such as Pinker see traits developing for specific purposes while exaptationists see specific capabilities arising from general purpose mechanisms.  Now of course within that there are nuanced positions.  Naive adaptionism for example can be seen in those wonderfully deterministic pictures from phrenology, and can also be found in modern theories that somewhat naively focus on mapping activity in the brain in a crude correlation with behaviour, at its worst it leads to the new calvinists of modern science who have abandoned free will in their limited view of human capability.

One of the interesting things to come out of the first day was the suggestion that we may have overemphasised the role of the cortex in out understanding of key aspects of human evolution.  The cerebellum (the purple bit in the picture) is associated with fine motor-control, but many scientists are now linking it with the evolution of language.  That for me (but not for others) matches Dunbar’s suggest that language replaced social grooming as the need for communication extends beyond communities of 150.  Lots of interesting evidence presented about the relative size of both cortex and cerebellum over time to back up the idea that its not all about higher thought.

Of course that also adds more weight to other ideas of extended consciousness, Andy Clarke on scaffolding for example.  The weight of evidence is increasingly pointing to a view of consciousness that makes the notion of a singularity  impossible and supports a more social, less atomistic view of society.  The argument was that group size (Dunbar) is not enough to explain the differences, but we also need to look at extractive foraging.  That is the need to develop fine motor control to get at difficult to extract food, the capability for which then becomes one of the exaptative aspects of language development.  That includes the ability to develop planned behaviour: putting together complex physical sequences gives rise to the ability to handle grammar for example and that is a major change as it means verbal fluency gives rise to syntax.  All of this means that language is a secondary adaption, a term some people prefer to exaptation.

Now while there was controversy over the validity of the term in biology there was less in culture and technology.  But for that you will have to wait a couple of days for me to pick up this subject again.

Acknowledgement to Rob Barton (Anthropology, Durham) for much of the material above, but the summary is my own responsibility.

My love of narrative and the sharing of stories predated my introduction to Cognitive Edge.

When I first learnt of CE’s operating methodology – that of using narrative and anecdotal material – drunk from immersion into the literature and suffering my social scientific hangover, I remember drawing many parallels of Cynefin and narrative-abductive research to works and scholars I had previously encountered. Of these, the first name that floated to mind was Pierre Bourdieu and his concept of habitus; quite naturally, considering my personal obsession with him.

Another name that followed quickly after was James C. Scott – “Weapons of the Weak”.

In the tradition of anthropology, sociology and traditional forms of ethnographic research, Scott immersed himself as an external observer into the social world of Southeast Asian peasants in the 1970s – where he believed new insights could be borne. In Weapons of the Weak, he studies the stories and rumours shared among peasants. These stories tell of small acts of resistance toward the elite among them; such as feet dragging, stealing of chickens out of the coops of pro-elite households and the burning of tractors which replaced their labour with mechanised forms.

The stories in themselves, provide rich contextual tapestry into the inner workings of the peasant moral economy. More interestingly though, is the way the sharing of these stories amongst peasants is seen as a ritualistic way of maintaining the balance of that moral economy. Individuals who were seen as not conforming to the dominant peasant mentality suffered the cruel brunt of being the subject of rumours.

In short, the sharing of stories and the purpose of gossip and rumours served as means of reinforcing, changing and auditing ways of life.

Scott’s purpose in this work was to overturn traditional Gramscian beliefs in hegemonic ideology and false consciousness – implying that subjects are mere passive receivers of ideology. As was discovered, there is a thread of ideological resistance in every level of subjective ontology. Conformance to hegemony is often carefully calculated, and seldom unthinking. Symbolic resistance takes place in manners which make “commonsense” to the agent in the system, and the narratives serve to provide the moral meaning for their actions.

This “commonsense” is, as we realise, not so common. Sense, or “rationality” to adopt a more scientific term, is a subjective experience – a sort of acquired taste. Or verstehen, as Max Weber calls this appreciation of these different forms of “commonsense” or “rationality”. No “rationality” is common to all – as the fiasco of neo-classical economics has displayed. Rational choice theory is not so “rational”. Human beings are fundamentally social and cultural – hot-blood and hormones, instinctive and habitual – rather, than objective calculators of utility. We make choices based on what makes “sense” to us; and this sense is coloured by culture, context, upbringing and learnt experience. These differ from individual to individual.

Although the peasants in Scott’s work did calculate how much they should conform to dominant ideology, they also did so based on their personal moral calibrations, reinforced by other agents in their environment. Their calculations involved careful balancing against how much they could involve themselves in small acts of symbolic resistance, and against what they would need to gain favour with other peasants. Their “moral economy” was in no way common, nor would it pass as “rational” if unschooled in their “commonsense”.

The study of narrative, I believe, provides that rich cultural smorgasbord that allows for the ability to temporarily disrupt accepted reality, step out of your version of “commonsense” and “rational”, to sample and understand the intricacies of someone else’s, and attempt to make sense of things through those lenses.

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This, if I may so humbly offer, is my version of the Cognitive Edge approach.

In the past few months, I’ve been advising a merger between two organisations happening near me. You can catch up on some of the details in the Merger Process category of my blog.

What’s been fascinating is the degree to which elements that were striking at the first session – when Dick, Sally, Anne, Meg and I had groups working in The Future, Backwards – have been denied and excused by various people, but keep coming to the surface.

The Future, Backwards is a tool I’ve used a lot in the past – to open up discussions about branding with a brewing company, to develop vision and strategy for a UK government department and to clarify next steps and embed learning for an internet startup. This time around, we were working with multiple audiences within two organisations.

We expected that both would find the Backwards element of the exercise reasonably easy – and that sharing between all the groups would be enlightening. Which turned out, mostly, to be the case. Looking forward we expected to produce some real differences of opinion, but on this occasion people tended to go for generalisations and bland thoughts, so differences in The Future were less evident.

There were certainly no driving ideas or aspirations. Rather depressing, given the circumstances and the opportunities.

The de facto leader of the group that struggled to produce the Backwards element – sitting semi-sullenly, insisting that “well, nothing happened, no-one told us anything” – after the event spent some considerable time lobbying leadership that they had been misled in the exercise. It was fortunate in many ways that I’d been paying particular attention to that group for other reasons, so knew exactly what had been going on.

Recently, I’ve had cause to reflect on how it’s progressed. The signs and signals were there right from the start.

The overall direction of the group has been lacking – there’s been progress, but it’s been driven more by current need and difficulties than by any over-arching picture. The lack of coherent Futures is worth watching in future.

The leadership of one organisation (the one that drove the merger) has proved to be the driving force, along with the overall leader of the merged organisation. The advisory body of the larger, more passive organisation seems on the verge of disintegrating. (For reasons of tact, I hadn’t mentioned in my original post that this advisory body didn’t manage to produce anyone to participate in the Future, Backwards exercise.)

And the one truly negative voice in all of this (there has been a staff survey recently) appears to be (it is anonymous, but the comments give a strong indication) the leader of the group that found Backwards difficult. The rest of that group, interestingly, are not of the same mind.

So some interesting early signals that I’ll direct attention to more strongly next time. Not to say that they will necessarily result in anything particular – no prediction – but simply to increase anticipatory awareness.

I read this absolutely rollicking article on human stupidity and its implications on society a few months back and I suspect it has my attention forever and will make me link a lot of what I know with the logic that it applies. The article has flavours of social economics, psychology, human behavior and humor. A simultaneously wonderful, entertaining and thought-provoking article, in my perception. Highly recommended.

If you are wondering where I might go from here, I think there’s a link between knowledge management and the human behavior referred to in the article. Caveat: The rest of this post may not make sense unless you read the article first.

I think the pursuit of knowledge management is a precise and perfect example of the effort to be intelligent, relating to the Intelligence block in the article – as opposed to the other three blocks called H (Helpless), B (Bandit) and S (Stupid) – because it is about yielding a gain to yourself while causing a gain to others as well. Both Knowledge Management as well as Intelligence (as referred to in this article), are after all, about a combination of sharing and learning or collaborating (working together to achieve something).

At the risk of sounding somewhat obsessed with knowledge and being idealistic, pursuing Knowledge Management in its truest sense, I believe, will put us all – in due course of time – in the I (Intelligent) block and help the organization/society as a whole (even though sometimes it may seem like we are in the H (Helpless) block when we come across some Bandits who only want to use our material but not share anything that they may have created or discovered). Positive thinking will lead us to perhaps converting the “Bandits” and “Helpless” into “Intelligent” people who are always looking for a win-win situation.