What's Next in Design for Global Health? How Design and Global Health Must Adapt for a Preferable Future

"Design's core principles around setting strategy based on empathy and the user's voice, investing deeply in understanding context, 'failing fast' and iterating, and end-to-end problem solving are highly applicable to addressing challenges of global health..."

Design for global health - the implementation of design methods in the development of global health products and services - gives voice to the need for empathy, equity, and inclusion in the field of global health. This commentary traces the influences that have shaped the practice of design for global health, describes the state of the emerging field, and envisions the future that awaits those working to create health equity through design.

The commentary opens by offering a brief history of design for global health, which represents a convergence of relatively new fields. In the 1990s, some hospital systems and medical device companies began employing designers to not just improve products but to strengthen patient awareness and engagement. Later, the Development by Design conference in 2002 in Bangalore, India, marked the emergence of "design for good" programmes at universities and small non-governmental organisations (NGOs). However, as reported here, the transition from design as a set of tools (to add value to a project) to an ethos fully integrated throughout strategy and process (that drives change in large complex systems) is in its early stages and is far from full realised.

The need for such a transition to actualisation of design's potential is necessary, according to the authors, because it "offers a means to ensure all voices - patients, families, health care providers, maintenance technicians, cleaners, distributors, policy makers, responsible government officials, and others - are all heard in conceiving and developing solutions that range from devices and physical work environments to innovative strategies and improved services. Design offers invaluable tools to deeply understand problems and related stakeholders, adapt and develop solutions, as well as anticipate and prepare for the future."

Thinking about that future, the authors propose a 3-fold vision for the future role of design in global health that reflects their commitment to equity:

1. A preferable future that shifts the focus from health care back to the health of individuals through user-led design: Design advocates for the patient's well-being to be at the centre of healthcare provision, with healthcare providers (who are also users) in a supportive role. User-led health care happens through initiatives such as the creation of youth advisory committees that select community health workers to serve them, for instance. For a preferred future, the design process engages the 4 voices of design (see figure above) in a process of guided co-creation that involves:
   • Defining the challenge to be addressed, the range of stakeholders and users, and who they believe are the ultimate customers, as part of the intent phase;
   • Gaining a deep understanding of the challenge, context, and people involved, as part of the exploration phase;
   • Rapidly generating prototypes and testing new ideas that speak to the defined challenges through an iterative process based on stakeholder input, as part of the innovation phase; and
   • Iterating purposefully to ensure the selected solution performs as intended in real environments while meeting other requirements, as part of the implementation phase.

   The authors offer 2 examples of approaches that sought a preferred future with preventative health initiatives: 1 that did not work (a fear-based approach to behaviour change), and 1 that did. Experience across a range of geographies suggests that preventative healthcare initiatives are more successful when they: offer opportunities that fit well with people's lifestyles, constraints, and schedules; promote social interactions; and provide positive reinforcement.

2. A plausible future that leverages design's collaborative and continuous learning principles to encompass ecosystems: The authors suggest that a plausible future focuses on improving the health of human beings and the planet in union, with a focus on resilient and large-scale solutions. Life-centred design (LCD) offers an approach to product, service, and systems design that encompasses people, profit, and the planet. The following resources can be used, preferably in a layered fashion, to integrate LCD when developing strategies and solutions: product lifecycle analysis; product-service systems; and regenerative design practices. As an example of the latter: Butaro District Hospital in Rwanda was designed to mitigate and reduce the transmission of airborne disease by leveraging indoor and outdoor space, the surrounding geography, and natural cross-ventilation. One guidepost in considering integration of LCD: Change must be driven at the institutional level by global health's "voices of intent" (again, see above figure) to affect the fundamentals of society, including industry and sectoral norms and values, sociocultural practices, and economies.
3. A possible future that rallies the co-creative and imaginative powers of individuals and institutions through speculative design: From the authors' perspective, the COVID-19 pandemic shed light on the "need to truly operate with resilience and responsiveness at a global scale, and in a manner that is equitable, inclusive, and radically collaborative..." In the context of global health, a speculative design process would involve looking at factors that do not figure prominently in the discourse at the moment but may have a strong influence on how health care is sought and delivered in the coming decades - e.g., linkages between health, financial, and climatic vulnerabilities of communities. Speculative design brings various actors together, helps conceptualise the future, and facilitates conversations on the values, intent, and directions that current systems and organisations are designed for and how they must be recalibrated.

In conclusion: "Global health, as a sector, has the knowledge and experience of history and diverse societies to address health challenges throughout the world. Design enables us to better act on this knowledge, engaging both users and communities to develop lasting sustainable solutions that create equity and impact. Design can best contribute to reform the next wave of health revolution by addressing misalignments in existing global health practice and shifting focus from health care to health of broader ecologies."