COVID-19 and inequity — public health needs a third revolution
We need a new framework to solve problems in the wake of COVID-19
The coronavirus outbreak is shining a spotlight on a large and important trend that has largely been missing from public conversation. The issues that will shape the next millennia of human history are what political scientists call "wicked problems."
Addressing these kinds of issues requires new ways to manage public issues that cut across disciplines and are shaped by paradoxes and ambiguity. They are problems that are difficult to manage and almost impossible to solve because of incomplete and/or contradictory knowledge, the large number of constituencies with differing opinions, the complex economic impacts and the interconnected nature of these problems with other problems.
The rise of wicked problems means that the public issues we increasingly face are hard to even define. They are multifaceted and look different at the local, regional, national and global level. Wicked problems make it hard to even develop consensus on defining the problem, as is the case with COVID-19.
For instance, any effective response to COVID-19 requires input from public health professionals, economists, social workers, psychologists and more. It also requires coordination across local, regional, national and global communities.
Historically, we have faced problems that were much more localized and one-dimensional. This allowed policy makers to break complex problems into their component parts and then assign the component to a profession that comes up with a solution for the rest of us to follow. Often, this is done by assigning an issue to a governmental agency that is filled with talented professionals who are used to thinking within the lane of their profession.
This doesn't work when problems have complex and intertwined causes, present incomplete understandings and require adaptable responses. Addressing one component of a wicked problem is the equivalent to playing professional "Whack a Mole."
The coronavirus crisis is the kind of classic wicked problem that political scientists and others have been warning will become more prevalent and important. It is an immense public health crisis whose origins cannot be reduced to a single action or place.
The response can't be reduced to a single issue or implemented in a narrow geographic place. The origins, impacts and responses are rooted in economic changes, health trends, technological advancements, demographic shifts, environmental decay, political movements and cultural dynamics.
Further, the coronavirus will require management across time. It's not going to disappear anytime soon, but the nature of the problem will change over time. What started as a public health challenge has become an immense economic challenge that is impacting mental health, cultural divides, and geopolitical tensions and environmental processes.
What do we need to do?
First, we need well-funded global institutions that have the authority to coordinate responses across geographic regions. This is the necessary but not sufficient condition.
Second, we need reformulated institutions - local, regional, national and global - that can both break wicked problems into understandable component parts while simultaneously bringing professionals together across disciplines to listen and learn from each other.
It won't work to have one agency focused on health, another on community and a third on the economy with a small group of non-experts at the top trying to weave it all together. One starting place for this model is Army Gen.Stanley McCrystal's approach of moving from rigid hierarchies to teams of teams.
Third, we need to include citizens in the conversations. Citizens have important stored knowledge about impacts, preferences and likely reactions and results from different policy responses. Citizens also respond better to policy approaches that they perceive are done with them not to them.
Finally, we need to embrace a different form of decision making that can handle complexity and ambiguity. One example is design thinking, which is a non-linear adaptive way of approaching problems. Design thinking is iterative. It focuses on understanding users, constantly challenging assumptions and redefining problems.
The process starts by defining a problem broadly and creating innovative solutions which are prototyped, tested and then refined. The key to design thinking is understanding that human and community needs don't really change but they are complex with lots of needs that exist in tension. Policy responses have to be designed and redesigned with those needs front and center.
Design thinking's roots are in two facets of American culture - entrepreneurship and the liberal arts. It is well suited to wicked problems for three particular reasons: It starts from a premise that solutions are not solutions if they don't work for the people who they are designed to help.
Second, solutions change the problem you are trying to address which then requires a different solution. And third, different professional views are brought into the process early to ensure the question is framed differently. The goal of design thinking is not to solve a problem but rather to find a solution that moves things along.
The coronavirus crisis is today's issue, but we also face other wicked problems like climate change and global inequality. Wicked problems require us to enlarge our thinking and embrace other forms of decision making that will help us lean into complexity with the humility, empathy, reflection and skills to manage them in the years ahead.
Adam Weinberg is the president of Denison University in Granville, Ohio.