The Design Observer Twenty

Ernest Beck | Event-Aspen

Aspen Design Summit: CDC and Healthy Aging: "5over50" Funding Proposal

Mission Statement:
To create a national branded program with deep community roots that encourages Americans over the age of 50 to take part in a series of basic health measures aimed at preventing or detecting the major illnesses that occur in this age group.

The Facts:

The U.S. is on the verge of an aging revolution. By 2015, one of every five Americans will be between the ages of 50 and 64 — for a total of 70 million people in this age group. Another 40 million people will be 65 or older. Chronic illnesses such as heart disease, cancer and infectious diseases take a heavy toll on older adults, and increase demands on the public health care system and aging services.

Five routine medical interventions delivered to men or women 50 and older can detect such diseases at earlier and more treatable stages, or can prevent the onset of these illnesses altogether. These measures are:
  1. Influenza Vaccinations
  2. Pneumonia Vaccinations
  3. Colorectal Cancer Screening
  4. Women’s Cancer Screening (Breast & Cervical)
  5. Cardiovascular Disease Screening

The benefits that come with more effective delivery of these services stretch far beyond individual well-being: a healthy aging population will be a boon to families and communities, and make a valuable contribution to every aspect of society.

The Challenge:
Despite the relative availability and low cost of these services, less than 25% of adults between 50 and 64 receive recommended screenings and vaccinations on an annual basis. And even with universal Medicare coverage, less than 40% of adults over the age of 65 are up-to-date with these basic preventive services.

Why not? Because it means a trip to the doctor’s office, and we rarely go to a doctor unless we are sick. And doctors are too busy treating people who are sick to spend time on prevention. Moreover, many older adults aren’t aware of the need for preventive services, or they have inadequate or no health insurance to cover the costs.

Our Goal:
To establish a program that makes the delivery of these services more accessible to people over 50 and increases their motivation to seek out these basic measures on a regular basis.

Our Vision:
The "5over50" program will combine communications strategies that educate and motivate in a powerful, surprising, and meaningful way, with expanded provision of services by health professionals in non-traditional healthcare settings and in physician offices, as well as increased engagement with families and loved ones.

Our Request:
An estimated $100,000 is required to support the initial development of the program. We are currently seeking four keystone sponsors to invest $25,000 to fund an initial phase of work that will include: the development of a communications strategy; outreach to potential community and institutional partners; and design elements, such as website design, and collateral communication materials. We consider this a critical first step toward a pilot program. This initial investment will provide for the following:
  • Create a tangible communications strategy and materials validated with sample users
  • Secure pilot partners for the project and schedule near term pilots in targeted inner-city and rural communities (within 12 months)
  • Develop a longer term 3-5 year roadmap
  • Establish funding goals and targets for pilots and a nationwide launch
  • Establish an advisory board and organizational structure to carry this initiative forward

Our Team:
The "5over50" program was conceived by a multi-disciplinary team of experts from the healthcare, communications, and design communities at the 2009 Aspen Design Summit, an event supported by the Rockefeller Foundation (with Winterhouse Institute and AIGA as organizers) aimed at addressing large-scale national and global problems with design solutions. The Summit focused on how to advance the concept of design for social change by pairing designers with nonprofits and other organizations to work on specific problems such as health, education and rural poverty. Design for social change is a way of thinking that encourages designers to use their skills, knowledge and experience to improve social well-being. At the Aspen Summit, designers in the "5over50" project collaborated with representatives from the Centers for Disease Control and Prevention (CDC), Mayo Clinic, AARP and AIGA, all organizations that are likely to be partners in this initiative.

Board of Advisors:
We have already assembled an initial set of advisors from government and industry including the following:
  1. Lynda Anderson, Director, Healthy Aging Program, CDC
  2. Dr. Nicholas LaRusso, Director, Mayo Clinic Center for Innovation
  3. Dr. Douglas Shenson, Executive Director, SPARC
  4. William Drenttel, Director, Winterhouse Institute
  5. Richard Grefé, Executive Director, AIGA

Our Strategy:
There are two critical elements to accomplishing the goal:
  1. A comprehensive messaging campaign designed to engage the interest of older adults and to mobilize them to take action. This design approach should highlight innovative and non-traditional ways and occasions share information and deliver the 5 services.
  2. A permanent, local infrastructure comprising public health agencies and organizations that take responsibility for the delivery of preventative services.

Element 1: Create fresh opportunities for the promotion and delivery of preventive services with a focus on a segment of the population (50-60) that has not been extensively targeted before (such as those 60 and over). For the most part this group doesn’t consider itself at risk, so the goal is to reach these people in innovative ways with a relevant, positive message: namely, that they can avoid many health risks (and costs) in the future by taking a few simple preventive steps today.

Our strategy is based on reaching this audience through the relationships that are most meaningful. What important touch points, relationships and events can be leveraged to deliver the "5over50" messages? What are the attitudes and assumptions that contribute to the low rate of compliance for these screenings?

We have conducted some initial user research and collaborated with leading experts from the CDC, AARP, Mayo Clinic and other organizations to identify key opportunities related to:
  • Messages
    Most people have tuned out the steady stream of messages delivered by the mainstream media and medical community. We will create innovative and surprising ways to deliver messages that engage the public’s attention and get them talking. Our program will include thoughtful use of artifacts and reminders to augment more conventional online and print communication vehicles.
  • Social and kinship networks
    For most people in our target demographic, family and social relationships are deeply important. An essential part of our communications strategy will be to leverage these influential relationships as a way to motivate and drive action.
  • Occasions
    Families tend to gather around several key holiday times (Thanksgiving, 4th of July, Christmas, Labor/Memorial Day, significant religious events). We will examine whether alignment with a specific occasion or event could work for family members to reinforce the "5over50" messages and build patterns of regular engagement with these services on an annual basis.
  • Business opportunities
    The workplace will be a key venue for the promotion and delivery of these services. We will explore partnerships with employers and non-traditional approaches to care delivery through mobile and workplace solutions.
  • Locations
    Where do these people live, shop, work, and play? It is clear that people will not go out of their way to engage with these services. So we will look for targeted opportunities, and strategic partnerships, that embed these services into everyday situations. We will also consider the right ‘pairings’: contexts in which these services will be complementary, and not out of place.
  • Online Social Media
    This demographic is the fastest growing segment of user activity for online social media, so this will be a key aspect of our approach. We will look to identify and reward key influencers online who are able to deliver this message and increase awareness within their community, providing them with training and tools to help them engage friends and family in a meaningful dialogue regarding the value of preventive care in this age group.

This communication strategy will leverage the capabilities of the world-class design partners that have signed on to support the "5over50" program, including frogdesign, SchwartzPowell, etc. These partners have agreed to contribute their resources at a greatly discounted rate to support this program.

Element 2: The program will require a provider and community infrastructure that is permanent and universal, and has experience in health service delivery. In this regard, the nonprofit SPARC (Sickness Prevention Achieved through Regional Collaboration) is an excellent partner for cooperation and has been closely involved in the development of this strategy.

SPARC is a program designed to bring preventive health care services to individuals living in the tri-state area of eastern New York, northwestern Connecticut, and southwestern Massachusetts. Largely the creation of physician Douglas Shenson, SPARC has provided primary care services in a number of innovative ways, such as its “Vote and Vax” campaign, a strategy that referred senior citizens for vaccinations and appointments for cancer screenings as they were approaching or leaving polling places on Election Day.

SPARC has shown documented success in broadening the use of recommended preventive services among older adults. A rigorous evaluation supported by CDC found increases in immunizations for influenza and pneumococcal disease, and screening for breast, cervical, and colorectal cancers as well as elevated cholesterol and high blood pressure. By 2008, SPARC had delivered more than 21,000 flu shots at 331 polling places in 42 states.

SPARC’s approach is to establish collaboration and coordination among a wide variety of community agencies and organizations (e.g., local health department, area agency on aging, health care providers, and other key players) with a vested interest in improving the health of older adults. SPARC does not itself deliver services; rather, it creates, facilitates, and monitors communitywide strategies that make it easier for older adults to get their screenings and immunizations in places convenient for them.

As such, SPARC’s experience, knowledge and established infrastructure would:
  1. Provide an excellent foundation for a pilot project and possibly long term cooperation and expansion.
  2. SPARC’s platform and presence in the public health grid can be used as a way for the "5over50" design elements — such as motivation, messaging, and access — to be fused with a respected, ongoing and established organization.

In this phase, we will work closely with SPARC to define a targeted plan for piloting "5over50" in an inner-city community. We will look to coordinate our activities directly with SPARC leadership in a targeted community such as downtown Atlanta so that we can connect our strategy directly with service providers. And use SPARC to help demonstrate positive outcomes such as the reach, effectiveness, and adoption of our approach to delivering critical prevention services.

We will also look to the Mayo Clinic and other partners to identify a target population in a rural community to pilot the "5over50" program. By demonstrating the validity of our approach in these two very different types of communities in the pilot phase, we believe we can make a strong case for a national rollout and government support through CDC and other channels.

We believe the "5over50" program has significant merit as part of the country’s ongoing healthcare overhaul and efforts to expand preventive health services. It represents a unique collaboration between designers who have embraced social change and the public health sector. It is an opportunity to demonstrate that partnership and the potential for positive social impact in the health sector through new and innovative collaboration models.

PDF of this document is available here.

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