Turning the Health World Upside Down
There’s a growing acceptance of the links between health, wealth and wider society. Not just the impact of wealth inequalities on measures like life expectancy. But the importance of fixing the underlying social causes of medical problems, rather than just administering the medicine and wondering why the patient doesn’t get better.
It’s convenient to frame this as a Third World problem. And while it is, it’s also a problem within and between developed countries. For example, people from one area of Glasgow (in Scotland) live a decade longer than people residing in another area of the same city, in spite of (theoretically) having access to precisely the same medical expertise.
A most basic analysis of Great Britain (and much of the developed world) reveals an organizational chasm, which most people are not prepared to cross: For example, medical services and social care provision are completely different activities – separate funding, differing structures, responsibilities, professional bodies. Even though individual “patients” shift seamlessly between them. It’s an organisational situation made worse by the difficulty both groups seem to have integrating with anything – in my experience (largely failing to integrate public transport into health and social services), a combination of:
- The intrinsic (internal) complexity of the service itself, which leaves little mental capacity for also dealing with “external” factors.
- The tendency to be staffed by those with people-orientated skills, who are often less able to think strategically or in abstract.
- The dominance of the government, with a natural tendency towards bureaucracy and politicized (irrational) decision making.
Complexity is the biggest problem, because it keeps getting worse: More (medical) conditions and treatments to know about, higher public expectations, greater interdependence between different cultures and areas of the world. Inability to manage growing complexity ultimately threatens modern civilization – it will probably be one of the defining problems of the current age. So adding even further complexity in the form of understanding about “fringe issues” is far from straightforward.
Beyond these practicalities lurk difficult moral debates – literally, buying life. Public policy doesn’t come much harder than this.
Into this arena steps Nigel Crisp. Former holder of various senior positions within health administration, now a member of the UK’s House of Lords. Lord Crisp’s ideas try to “kill 2 birds with one stone”: For the developed world to adopt some of the simple, but more holistic approaches to health/society found in the less developed world, rather than merely exporting the less-than-perfect approach developed in countries like Britain.
To understand Crisp’s argument requires several sacred cows to be scarified: That institutions like the National Health Service (which in Britain is increasingly synonymous with nationhood, and so beyond criticism) are not perfect. That places like Africa aren’t solely populated by people that “need aid” (the unfortunate, but popular image that emerged from the famines of the 1980s). That the highest level of training and attainment isn’t necessarily the optimum solution (counter to most capitalist cultures). If you’ve managed to get that far, the political and organisational changes implied are still genuinely revolutionary: To paraphrase one commenter, “government simply doesn’t turn itself upside down”.
While it is very easy to decry Nigel Crisp’s approach as idealistic, even naively impractical, he is addressing a serious contemporary problem. And his broad thinking exposes a lot of unpleasant truths. This article is based on a lecture Crisp gave to a (mostly) medical audience at the University of Edinburgh. And the response of his audience. The lecture was based on his book, Turning the World Upside Down: the search for global health in the 21st Century (which I have not read). Read more of this article »
Alex van Someren’s Lucky Acorns
Alex van Someren is one of those rare people, without whom our modern world would probably be a little bit different. From writing the first book about programming ARM architecture, the computer processor which now sits at the core of almost every mobile phone on the planet. To providing the technology that made Secure Socket Layer (SSL) more commercially viable, and helped enable the ecommerce internet revolution of the late 1990s.
Yet his story is fascinating because it is a definitive study in luck: Not just pure chance. But the type of luck that comes from a combination of unusual personal interests, social circumstance, and the active pursuit of something different.
It’s a reality that few “successful” entrepreneurial people acknowledge, because it’s an uncomfortable reality: It doesn’t fit neatly into a 5-point plan for instant fame and fortune [also see box below]. And it leaves a nagging doubt that the outcome could easily have been unsuccessful. And while I suspect that Alex isn’t comfortable with pure chance, he provides ample examples of how other elements of luck can be biased. How the odds can be improved. The dice loaded more favourably.
Those examples make Alex van Someren worth understanding. This article is based on a talk he gave to the Edinburgh Informatics Forum. Read more of this article »
Michael Gazzaniga on the Science of Mind Constraining Matter
Can neuroscience explain it? You know – consciousness, being, the number 42. And if everything you thought you were transpired to be nothing more than an easily deceived heap of neurons, would that trouble “you”?
During October 2009, Michael Gazzaniga gave a fascinating series of Gifford lectures exploring how our brains process the information that gives us our sense of “I”. Gazzaniga drew extensively from neuropsychological studies of people with “split brains” (explained later) to develop the notion of a single “interpreter” within the brain – a part of the brain that analyses all the data available for meaning.
Michael Gazzaniga then attempted to rationalise the interpreter, concluding that our focus should be on the interactions of people, not the brain itself. This logic was then expanded to wider society – social structure, interaction, and law. Those later thoughts raised many more questions than were answered.
This article attempts to summarise the key themes in a non-technical manner, with a few naive attempts to interrogate the theories developed. This is my interpretation of 6 hours of lectures. Interpretation, because I tend to recreate Gazzaniga’s conclusions by re-analysing the information presented. With a complex topic such as this, it is likely that some of my interpretations will differ from his. Sections titled “Interlude” are entirely my analysis. Read more of this article »
Optimism
As I write, the United Kingdom is in the midst of a national election campaign. A month during which politicians vie to confuse the electorate with big numbers. Politics is suddenly ravaged by intangibility, because the national economy is unable to sustain the usual tangible proxies for a better life – “more schools and hospitals” – and because the tangible results of fixing that economy tend to be unattractive – “less schools and hospitals”. So the best political strategy is not explaining the consequence of choices in a language ordinary people can understand.
Do you like the sound of £100 million ($150 million)? Can I tempt you with £160 billion? Expressing these figures per person in the population can be useful. The first figure is one bar of luxury chocolate for everyone. Doesn’t sound so big now, does it? The second figure is like everyone having a £2,500 bank overdraft (loan). Strange that, because indirectly, we do.
Unfortunately, applying the economics of household groceries to major items of government expenditure introduces certainty. The idea that one can visit a store where luxury chocolate bars are sold for precisely £1.70. Yet many large elements of government expenditure are akin to ordering a chocolate bar years before it can be eaten, for a price that transpires to be somewhere between £1 and £5.
Larger businesses will be familiar with this concept. It’s called risk. Such businesses are often far more interested in what “it might cost” (£5) than what “it will cost” (£1.70), because what it might cost might lead the business to bankruptcy.
The national economy is chaotic in its complexity, but overall, things should average out. So long as all the assumptions are broadly reasonable: Ultimately some will earn/cost more, some less. Short-term in-balance can be solved by (basically) printing more money, and then down-grading future assumptions until everything is back in balance.
However, this breeds a form of arrogance. A sense that government doesn’t need to consider the possibilities. That we can deliver a radical new policy – that has never been done before – and, in spite of it never having been done before, we know precisely how much it is going to cost. Just like a bar of chocolate.
Unfortunately, assumptions tend towards optimism. On average, projected costs are less than actual costs. This isn’t just a problem for accountants. It means that decisions are taken which do not reflect reality. Potentially leading to a Disneyland scenario, where everything is affordable until after the decision is taken, when suddenly everything has become too expensive. It ultimately challenges the validity of decisions, and in doing so, the moral authority of those that take them.
This article uses the Edinburgh Tram project to demonstrate the inherent uncertainty of large government infrastructure projects. It discusses the role of optimism in planning, and the methods used to reconcile planned optimism with subsequent reality. The article describes how the involvement of the private sector in public projects has evolved over the last 20 years, and the highlights the different time-scales applied to private investment and public choices. It concludes that optimism is not only unavoidable, but necessary. Rather, the true problem lies in tendency of people to demand certainty from the public sector, while accepting uncertainty in the private sector. Read more of this article »
Ian McCaig’s History of Lastminute.com
Ian McCaig, lastminute.com’s Chief Executive Officer, told the history of this online travel and lifestyle retailer to the Edinburgh Entrepreneurship Club.
From a stereotypical “dot com” baby in 1998, to the rapidly maturing teenager of 2010. Ian charted the way in which the business’s strategy, structure and ownership had evolved as it matured from something with the turnover of a small local pub, to a multi-billion enterprise. Covering the problems of merging acquired companies, the need to scale costs, and the change from a public (stock market) ownership to private equity.
This article is based on Ian’s talk. It concludes with some personal analysis of the future, with particular reference to my favorite topic, public transportation information… Read more of this article »
Financing Hyper-Virality in the Clouds
This article probes the implications of cloud computing for financing very rapidly distributed internet-based services and products. It contains rough, inadequately researched thoughts, sparked from discussions at the recent CloudCamp Scotland. Read more of this article »
WeeWorld
WeeWorld is a teen-orientated social network, best known for their customized avatars, “WeeMees”. WeeWorld has evolved into an eclectic mix of community, casual games, and virtual goods. Steve Young, creative director, spoke to a small group in Edinburgh. Steve discussed the motivations and behaviour of WeeWorld’s users, and explored the challenges of working with 2D WeeMees, particularly as they move into WeeWorld’s new virtual (synchronous) world.
Users
WeeWorld’s core market are teenagers, mostly in North America. Average age 16 (minimum 13, although younger users may simply lie about their age). 60% are female. The dominant market segment was characterised as “spoilt rich kids” – typically those with their own computers. Of the 23 million registered users, about a million visit the WeeWorld site each month, and 80,000 login each day.
Usage differs from other teen social networks, such as Gaia Online: Only 6% of logged-in users visit the site’s forums, while 80% alter their WeeMee. Teen worlds are evidently not generic.
WeeMees (from the Glaswegian, “little me”) can be placed within personalised 2D rooms (in the style of “cardboard theatre”), used as characters within casual games, or rendered as avatars in a new virtual world called, simply enough, “World”. WeeMees are also used on third party websites and services, including messenger services, such as AIM or Live. Initial ideas for WeeMees had resulted in a lot of avatars simply being copied. APIs now provide some control over how WeeMees are reused.
Users’ main aim is “to gather as many friends as possible”. And to chat in a variant of the English language that even JeffK would find almost unintelligible: $iNG-UL?
Virtual Goods
WeeMees can be customized for free: Body, clothes and accessories. However users can also buy “Points”, which can be spent on specific items.
Points can be purchased via PayPal transactions or pre-paid cards, which are sold in US stores. Kids tend to regard these mechanisms like free credit cards: They are not seen as real money.
People pay for “uniqueness”. However, items need not be complex: The most popular item sold is a simple Alice band.
The most fascinating revelation was that the introduction of the new synchronous (virtual) world doubled the sales of virtual goods. This “World” is not even out of beta testing yet. “World” places WeeMees in the same interactive space as one another. This contrasts to the other areas of the site, where WeeMees are not competing for space. I think that implies the more an avatar needs to stand out from the crowd, the more virtual “Bling” is worth to that avatar’s owner.
WeeWorld is keen to avoid its Points being traded as a virtual currency. Money can only be converted into Points, not back again.
Design
The key to WeeWorld’s success is “immersion”. The key to its revenue is “engagement”. These concepts guide development.
Although WeeMees are cartoon-like (in the style associated with South Park), customizations still need to reflect what people would wear in “real life”. For example, T-shirts branding needs to be subtle – a small logo on part of the garment.
The goal for user-generated content (customizations of WeeMees and rooms) is to make it hard for the user to create something that looks bad. For example, MySpace customisations can (and in my opinion, sadly often do) look terrible.
WeeWorld has adjusted to match conservative US culture. The cannabis plants created in early experiments are long gone. There are no alcoholic drinks. Negotiations with Walmart even forced WeeWorld to disable the customization of boob (brest) size.
The development of “World” posed an interest problem: How should WeeMees move? All the artwork and customizations had been designed for static display, without movement animations. The World uses embedded Flash objects to display information to users, so the amount of data transferred about other users’ movements needs to be minimal.
The solution was to make WeeMees hop. Users can also select a trajectory and fire their WeeMees in a particular direction. Navigating World’s 2D platform-ed environment is quite cereal, but strangely fun!
Development
Social networks are becoming more like virtual worlds, while virtual worlds are becoming more like social networks. WeeWorld is trying to steer a path down the middle. Like all the businesses involved, they are still “feeling their way”, finding out what works.
Development time-scales for WeeWorld (and similar products) are very short. Steve was somewhat frustrated that development of the “World” had taken a whole quarter (3 months). The contrast to video-game style virtual worlds is stark: Those typically take 3 years to construct.
WeeWorld use a Scrum/agile development process (which suits the constantly evolving product). Casual games (a commonly requested feature) are often out-sourced to other developers.
The ability to develop content quickly makes it very easy for good ideas to be copied by competitors. For example, Zwinky might seem remarkably similar…
