Designing the State’s Role as Enabler and Facilitator of Citizens and Communities
I’ve been conversing and collaborating with State of Oregon, Central City Concern and Governor Kitzhaber’s office over the past few months, and feel fuelled by the challenges, buoyed by the possibilities and confident enough in knowledge to proffer some thoughts on the subject of reducing poverty in Oregon and the broader US.
As a Brit I don’t have a lifetime’s understanding of the US welfare state, its cultural place and stigmas, and American politics overall when it comes to state provision on subjects as seemingly intractable as poverty.
Caveat aside, I can say that the tug-of-war between reducing the size of the state versus and the drive for equity through higher taxes and more service provision is not the correct dialectic to have.
The tantalizing possibility that lies just beyond the horizon is one of marrying the political right’s ideals of self-sufficiency with the left’s drive for equity. The ideal is to reduce the need for services for those in poverty. This can be achieved by the state shifting its role towards enabling people and communities to build their resilience and facilitating prosperity.
A naïve perspective, perhaps. But design can be instrumental in delivering on this third way. Designing services and systems for people from an empathic understanding of experiences, identifying barriers to service and championing the true needs of users can help improve efficacy as well as efficiency.
A design lens can free us from what organizational imperatives and biases affect the system and hold back performance and change. It allows us to ask challenging questions about what could be and to expose the barriers that stand in the way.
Taming the Octopus
One of the most striking things about the last 50 years since President Lynden Johnson launched America’s War on Poverty is the proliferation of services and institutions. State provision and costs have grown drastically to provide safety nets to those in deep poverty and services and assistance for those who fall below the poverty line. But so much of the state’s efforts seems to be waiting for when people eventually ‘qualify’. At that point it is so much more difficult to help people to bounce back. ‘Firefighting’ an overwhelming number of distressed people and families stretches resources to the brink. This leaves next to nothing to focus on helping people avoid such circumstances in the first place, thus dooming the system’s future to repeating the same approach.
The sheer number of services available has given rise to the need for ‘Navigator’ services. Staff roles, apps, websites and institutions have been established so that people may make sense of the plethora of tax breaks, services and assistance that they may access. Such services do well to embody the principle of seeing a person’s journey through the system from the individual’s perspective. But they highlight the fact that even between state departments and services housed in the same building there is a lack of co-ordination between them to simplify and improve touchpoints from a citizen’s perspective.
A coherent, consistent and clear journey requires a true holistic understanding of an individual’s context, needs and goals. This will help to provide more convenient access to more relevant and effective services in the right way and at the right time to guide them to self-sufficiency. The individual objectives and metrics of departments, initiatives and organizations, though well-meaning, do not add up to this.
The Redundancy of the Poverty Industry
By comparing recent shifts in the US healthcare industry to the current orientation of services for people in poverty, we can expose some of the traps of the ‘poverty industry’. The Affordable Care Act is not just about increasing access to the health care system. It also makes it possible to replace the ‘Sickness Industry’ (compensating number of treatments) with the ‘Wellness Industry’ (rewarding healthy outcomes). Services can inreasingly be geared towards encouraging and rewarding healthier lifestyles, preventing the chronic diseases which have a devastating cost on individuals and their support network of families and carers. The state can gradually reduce the need for hospital beds, traumatic operations and lifelong medication to manage serious illnesses.
Making provider roles such as community doctors responsible for spending a set budget on a community helps focus them on treating and reducing the most costly cases (financially and in human terms). It encourages proactivity, with providers analyzing data and seeking out ways to prevent people in danger of falling into the same circumstances from doing so. With funds increasingly freed up by this initial shift eventually more effort can be put towards keeping people fit and healthy, eating well and intervening early with potential physical and mental health problems.
Image Credit: UK Design CouncilRED launched Activmobs as a way to focus the discussion on state health provision towards preventative services. Imbuing health and wellness experts in communities to build knowledge and action towards healthier lives saves for the needs of hospital beds and chronic care in the future.
But culturally we haven’t moved the discussion on: Any newspaper will rail against chronic care facility closures and speak in terms of hospital beds. But looking at Norway, which has arguably the most successful health system in the world, we see that it has fewer hospital beds per capita than many developed countries because its healthier populace has less need for them. Clearly, however, it is a case of reducing demand before and as you reduce supply.
Similarly, the uncomfortable truth about moving people out of poverty and into sustainable independence is that it means the redundancy or scaling back of safety net services. This will have a huge impact on the state departments, non-profits and corporations that provide such reactive services. But asking the question ‘who profits from poverty?’ quickly reveals some likely candidates that may be happier with the status quo. This old paradigm should find itself in a world with increasingly fewer people to serve, encouraging an evolution to the provision of more ‘preventative’ services.
Design and its principles, practices, tools and processes have a role to play in understanding people’s holistic situations and co-ordinating services to be more navigable, accessible, efficient and effective. A design lens can uncover latent or unmet needs, expose underlying factors, as well as creating new services that facilitate independence and prosperity, and reduce the need for safety-net services.
A Holistic, User-Centered Perspective and Measurement
This sketch offers a holistic view of an individual’s resilience in different dimensions. As a tool it could help case workers and agencies to focus on dimensions where people are most vulnerable in order to have more sustainable impact.
The model of increasing provision and consumption of state, private sector and third-sector (non profit) services creates a dialog of siloed eligibility and disjointed targets, not holistic outcomes.
Interactions are geared towards scrutinizing whether people are eligible and can create counter-productive work-arounds and incentives for individuals to access those services. From an experience point of view, far from entitled, many citizens feel distressed, stigmatized, guilty and shameful about receiving state help. Services struggle to contribute towards the holistic outcome of getting that person to a place where they are truly independent, in all dimensions of their lives. Such a focus would mean a state worker’s mindset is shifted from ‘Do you qualify or not?’ to ‘Where and how can we help most?’
An anecdotal example is not being to access medicaid if you have (any) money in a savings account. Who would argue that a key part of avoiding poverty is financial preparedness? Access to fair financial services, education on budgeting and encouragement to create a safety cushion of money to protect against unexpected costs is crucial to independence. It is much more likely is it that if someone has to burn all their savings in order to qualify, they become more vulnerable and dependent on poverty services for longer.
All services should have license to consider a holistic view of someone’s resilience, and understand that assistance in one area can be undermined by a vulnerability in another. Providing break-fix health services to children with respiratory problems solves nothing if a family’s housing situation is unstable, poorly maintained, damp and there is a lack of money available for heating. Without solutions to those areas, those children will continue to fall back into poor health.
Enabling Communities to Create Services
The proliferation of ‘Prosperity Services’ will go some way to alleviate the strain on ‘Poverty Services’, particularly in the long run. But people do not want to live on handouts – they want to be self-sufficient. The producer-consumer model is not the best way to truly help people towards more prosperous lives.
The state should seek to shift its role from poverty services to prosperity services, but it should also seek to shift its role as provider to citizens, to facilitator of citizens.
Our services must see people in poverty as not just people with needs to be served, but in possession of skills, experiences and assets that are of value to others. This is the first step in enabling people to build their prosperity. Connecting assets within communities and sharing resources such as cars for transport to work, and enabling mothers and fathers to share childcare with other families helps free up more time to seek employment and work. The sharing economy has been the preserve of the middle classes for too long. Its principles of connecting assets and providing smart systems for people in poverty (with or without access to the internet) can enable people to find their own path to prosperity.
Imagining a small town 60 years ago (perhaps through rose-tinted glasses depending on your upbringing) we feel that these community interactions already existed. Neighbors looked after each others’ children, took turns walking them to school, carpooled to work, shared lawnmowers and loaned each other money in tight times.
Consumerism’s insistence on ownership over sharing, and the professionalization of services has left us feeling unqualified to help each other. We live more dispersed (from our immediate families and places of birth) than ever before in human history. This can exacerbate vulnerability, isolation and the creeping feeling that we must be 100% self-reliant to be safe from poverty. But true resilience comes from strong social fabric at a community level upwards, knowing our neighbors, having support networks, and feeling capable of helping.
Many people can move out of poverty and into prosperity if the state taps into the potential of its citizenry in smart, well designed ways. It should act as a facilitator of peer-to-peer services and the accreditor of people’s skills, environments, vehicles and tools that are needed to provide them. Such grass-roots service creation is conducive to skills building so that parents may find employment in teaching or childcare, or carpoolers and neighborhood delivery skills can be build upon to create qualified drivers and administrators.
The resources required for shifting from poverty to prosperity are already here, we just need to design new, better ways of harnessing them.