Tuesday, 22 October 2013

Computer says no...

Posted by Martin White

What happens when you bring together informed citizens, academics and a range of professionals, in mixed teams of 12 for a two-day simulation experiment to decide how to reduce the gap in life expectancy at age 55 between social classes by 50% in ten years? Well, quite a lot of things (more of which later), although none of which included fully achieving this objective. Nevertheless, that was the aim of Newcastle University’s ‘Healthy Life Simulation’, which had its first formal outing on 27-28th September 2013. 

The ‘game’ was developed “to bring fresh energy to finding new ways to tackle the unacceptable unfairness that currently exists in the time people can expect to live without debilitating illness”. Although an initiative of Newcastle University’s Biomedical Research Centre in Ageing and Chronic Diseases, some members of Fuse were asked to advise on the simulation model content and participate in the exercise as members of the ‘White Team’. This is the group in a traditional ‘war game’ that makes up the rules and provides expert advice to one or more of the competing teams. When they feel like it. Or not. Or changes the rules or context, when they feel like throwing a spanner in the works. It is a highly responsible job – but one in which you can also have a fair amount of fun.

Many of us in public health and related disciplines in the North East have participated over recent years in ‘accelerated solutions environment events’. Whilst not using the same adversarial approach as a ‘war game’, these offer the same kind of opportunity for concentrated, multidisciplinary, goal-oriented, group work on a future scenario. Hence, the overall dynamics of the healthy life simulation, including some excellent incidental learning and the warm glow of team building, came as no surprise. What I found more revealing, however, was the effect of direct competition. This of course brought out the best and worst in participants.

Socio-economic inequality is familiar to readers of this Blog. Everyone knows how wide the gap is in the North East and elsewhere in the UK. Or so you would have thought. Some of the lay participants were genuinely surprised at some of the data presented on inequalities, and many participants expressed disbelief at the relative lack of evidence to support their favoured strategies. So, the exercise may have had more value for the lay participants than professionals. Nevertheless, participating professionals also remarked that, being faced with the challenge of achieving an ambitious public health goal in a team did bring fresh energy to the challenge. And the learning was not just about the logic needed to address the challenge (i.e. playing the simulation effectively to identify the best options), but also about how the art of persuasion was needed to carry the team with you.

Many familiar themes emerged throughout and were prominent in the final plenary discussion. The health and well-being arena, now firmly located in local government, continues to suffer from the perennial challenges of long timescales but short-term funding, a mismatch between who pays and who benefits (local authority spends on prevention, NHS secondary care gains through reduced burden), and a preference for innovation despite a lack of evidence and evaluation. None of which helps us towards more evidence-informed public health at a local level.

So, what did I learn? For me it was a privilege to meet some extraordinary and committed individuals from entirely different fields who shared their expertise to develop and run the simulation. And to hear the inspirational stories of community members from the poorest areas of Newcastle, who deal first hand with the life expectancy gap from day to day, and are committed to bringing about change. I also learned much about how innovation, research and development are managed quite differently in the commercial sector. For example, there is a more hard-nosed approach to success and failure, and thus a willingness to disinvest in all but the best innovations, funnelling R&D towards sure-fire investments. All of which has got me thinking about our current model for translation. I think there are important implications for Fuse and for public health more generally. But developing a new model, even conceptually, may take a while. There are so many ways in which commerce is fundamentally different from the public sector. But, we desperately need new ideas, so this is a challenge worth pursuing. I hope I can report some progress on this front in due course.

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