EP 118: Designing Health Equity | Adriane Ackerman & Robert Fabricant
On today's episode, we are going to talk about designing for health equity.
Adriane Ackerman is a community convener, strategic innovator and life-long rabble-rouser. She currently directs several programs at the Pima County Health Department in Southern Arizona, including a $4 million grant program from the Department of Health and Human Services’ Office of Minority Health to Advance Health Literacy, the department’s new Cultural Health initiative with its pilot project, SaludArte, the emerging Pima County Network for Equity and Resilience (PCNER), and the first ever Office of Health Policy, Resilience, and Equity, all of which aim to increase health literacy and equity through innovative models, by elevating and centering the leadership of historically and contemporarily excluded communities. Adriane holds dual Bachelor’s degrees in Political Science and Urban & Public Affairs and seeks to bring the depth of her lived experience to bear as she convenes, facilitates and uplifts the work of harm reduction from within bureaucracies and community partnerships.
Robert Fabricant is Co-Founder and Partner of Dalberg Design, where he brings human-centered design and innovation services to clients looking for new, creative approaches to breakthrough innovation and expanded collaborations in the field of social impact and international development. Before Dalberg, Robert Fabricant was the Vice-President of Creative for frog design, where he managed frog’s global leadership across Design Research, Product Design, Software Design, and Experience Strategy. Robert writes about Design and Social Impact for publications like HBR, SSIR, Fast Company, Rotman Business Journal, MIT Tech Review, ChangeObserver, and Core77. He is a member of the adjunct faculty at NYU and SVA. His client portfolio includes experience across verticals including financial services and financial inclusion, social impact, mobile and technology, healthcare and public health, and media. Robert has an MPS in Design and Technology from NYU and a BA from Yale University.
Episode mentions and links:
https://www.adrianeackerman.com/
Adriane’s previous work: https://www.portlandpeoplescoalition.org/
https://dalberg.com/who-we-are/our-leadership/robert-fabricant/
Adriane’s restaurant rec: La Indita (a mixture of native Sonoran, Pascua Yaqui, and Tarascan cuisine)
Robert’s restaurant rec: Le Succulent
Follow Adriane: LinkedIn
Follow Rob: LinkedIn | Twitter
Episode Reflection
I really appreciated this week’s conversation with our two guests who each offered a unique perspective on the role of design in their work improving health equity in Tucson. It was especially valuable to hear Adriane’s perspective, as a public health professional and community advocate, how she was able to leverage human-centered design to shake up the status quo, using design to validate the reason we need to do things differently. One practical example she gave was where they were able to articulate a need for increased compensation for individuals who contribute their lived experience knowledge to the project. This likely rings true for anyone who has ever worked in community health or advocacy work, where we rely so much on the goodwill of community members to share their perspective frequently with zero compensation, while we know full well that without that perspective, whatever we are trying to accomplish will fail. Also, as Adriane mentioned, this process can be extractive because time and experience is valuable, no matter what socioeconomic background or technical expertise you have, and the status quo is to value technical expertise over lived expertise.
Overall, this week’s episode is a textbook case study on the importance and value in bringing the world of design and public health together. As much as those of us who seek to serve and promote health in our communities enter this space with the best intentions, human-centered practices do require a framework and language to be successfully deployed, and many of these tools exist within the designer’s toolkit. As Adriane described so well, “--design really embodies, at least when approached in this way, the idea of nothing about us without us.”
Written by Rob Pugliese
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Bon Ku: Welcome to another episode of Design Lab. I'm your host, Bon Ku. On today's episode, we are going to talk about designing for health equity.
We have two guests on for today, Adriane Ackerman and Robert Fabricant. Adriane is a community convener, strategic innovator, and lifelong rabble rouser. She directs several programs at the Pima County Health Department in Southern Arizona, including a 4 million dollar grant program from the Department of Health and Human Services Office of Minority Health to advance health literacy.
Though she's new to the public health profession, she has over 20 years of experience managing, administrating, facilitating, and convening partnerships within the public sector at the local, regional and national scale. Her proudest moments have come from her decades of work as a grassroots community organizer.
Robert Fabricant is a co-founder and partner of Dalberg Design, where he brings human-centered design to clients and he has expanded collaborations in the field of social impact and international development. Before Dahlberg, Robert was the Vice President of Creative for Frog Design, where he managed Frog's global leadership across design research, product design, software design, and experience strategy. He writes about design and social impact for publications like harvard Business Review, Fast Company, MIT Tech Review and Core77. He has won numerous design awards and is adjunct faculty at New York University and the School of Visual Arts in New York City, and he's the co-author of one of my favorite books, User-Friendly.
Visit our website. You can find it at designlabpod.com. There you can sign up for our newsletter. So each week our producer Rob Pugliese will send you show notes. You can learn more about the guest. And get links to related content, my favorite part is the guest recommendations for their favorite spot to take you for a meal. Follow me on Instagram at Dr B O N K U, on Twitter, at B O N K U. Go to Apple Podcast. Give us five stars, leave us a review. And you could do this on Spotify as well. You could rate us and follow us. Tell someone about the show. That is how you support us.
Now, my conversation with Adriane and Robert.
Interview
Bon Ku: Adrian. Robert, welcome to Design Lab. I'm so excited to talk about your project.
Adriane Ackerman: Thank you so much, Bon I'm so excited to be here.
Robert Fabricant: Yeah, it's great to be here.
Bon Ku: You are working on something very cool in Tucson, Arizona. Can you give us a background on the project and that origin story of how did you come to work together?
Adriane Ackerman: Yeah, absolutely. So I think it's important to contextualize we're headquartered in Tucson, Arizona, but this is a partnership between Dalberg Design and the Pima County Health Department. So, Pima County is one of the largest geographic counties in the nation, and we also share the longest contiguous border with Mexico of any, any county in the nation.
So we have a really diverse population and a lot of it is, comprised of rural and indigenous communities outside of the Tucson metro area. And in 2021, we got a new department director, Dr. Teresa Cullen who's just really visionary, and has a wealth of background in the field of informatics and had been exposed to a lot of projects internationally that combined human-centered design and behavioral science to increase community-centered outcomes for, health programmatic, delivery and services, et cetera.
So she really wanted to bring that sort of collaboration to Pima County. To further contextualize, you know, we, Arizona in the recent years has gone a bit more blue, but we're definitely a purple state. we're a purple county in kind of really red territory, so bringing this sort of what is to us innovative and futuristic design thinking into programmatic development, at a pretty underfunded and mostly grant funded, you know, Southern Arizona Health Department is really breaking the box in a lot of ways.
Bon Ku: You mean public health departments aren't oozing with billions and millions of dollars.
Adriane Ackerman: Well, not this one at least. Yeah. So, I was brought into this position to help operationalize this project and had the good fortune of stewarding the county through its first kind of RFP process soliciting a human-centered design agency. And, you know, that presented really unique first time experiences and barriers because when you're designing for a contract, when you don't know the outcome of the project, it's something that like government is not used to.
And so, Yeah, we all kind of cut our teeth together.
Bon Ku: Now that's so like unusual, like this doesn't happen frequently. In fact, I, I don't think I know of a case of a county health department putting out a R F P for a design agency. Like where did that come from?
Adriane Ackerman: Well, we were, um, Fortunate enough to be one of 74 recipients of a Covid 19 funding grant from the Office of Minority Health to advance health literacy and mitigate Covid 19, among priority populations. And for us, that population that we really honed in on were Hispanic and Latin folks of childbearing age with the ability to become pregnant. Because we, you know, based on, uh, data that we were seeing nationwide around, hesitancy to take the Covid 19 vaccine among pregnant people, we drilled down on that regionally and found that Hispanic and Latin A folks were even more hesitant. And so we really wanted to reach that demographic.
And like I said, Dr. Cullen had the vision to say, you know, the only way we're really going to reach this community that is, historically difficult for us to penetrate as a department is to bring that community into the center of the problem definition and solutioning, you know, process. So, I have to credit her vision.
I have to credit, how intrepid some of our key partners were in, like bringing this together in a very vague and nebulous way. We had to, get a local Federally Qualified Health Center, the University for evaluation purposes and other community-based organizations on board by saying, contract with us.
We'll give you all this money. We don't know what we're doing yet, and you're gonna have to wait, wait, wait until we go through this process, and then it's gonna be full steam ahead so we can achieve these things by the end of our project performance period.
Bon Ku: So, Robert, are you just scouring RFPs in the Tucson, Arizona area? Like how did Dahlberg design get involved? Like how do you even hear about this rfp?
Robert Fabricant: It is a bit of a story and, and it has elements of good fortune sprinkled through it, like pixie dust, in and around, you know, legacy processes that are, that as Adrian's not fully revealing are just, just incredibly cumbersome. What I will say is that, you know, globally, our team works a lot with local government, state and local government. For example, in India, in the state of Bihar. But normally we have the funder right at the table with us, and that's what drives it.
So, that doesn't mean the agenda can't change. We were doing some work there and, and the, district health department decided that COVID wasn't a priority anymore and we had to change no matter what, what the funder was looking for.
But we've been looking in the US to find an opportunity to partner with government. We've done a little bit here in New York. And if you'd asked me whether it would've been Arizona, I don't think I would've imagined it would've been Arizona. But the reason we lucked out is I have, someone who used to work for me was based in Phoenix and teaches there, in a sort of design lab.
And it was on her radar, but she only reached out about four or five days before it was due.
Bon Ku: What? I mean, that's pretty incredible to get together, to get a RFP in a couple of days.
Robert Fabricant: We, we double down on it and just to give you a, a few little details. So it had to be delivered printed version of the, of the proposal in triplicate, had to be delivered in person, by noon on like a Monday.
And we picked this up on like a Wednesday or Thursday. And not only that, this is my favorite part. Digital copies had to be submitted on a thumb drive. A physical thumb drive. So fortunately she was in Phoenix and she drove down Priyanka and she helped us get this up and running. So it was, was, it was a huge bit of help, in that sense.
But what, what I will say is, you know, it really takes, even though I wouldn't necessarily even imagine that it was gonna be Tucson County or what have you, a couple things struck us immediately. Number one is it takes so much vision and determination. You have to have a change maker inside government.
Anytime you're working with government, and you have to understand that the pain that we went through to submit the proposals at half a percent of what Adrian went through in setting up the rfp. So you have to immediately kind of appreciate that. So that was the first thing. The second thing is we quickly got to know how interesting a place Tucson was, and in particular Dr. Cullen's ambition to make it the county in the country with the highest health equity. So she set a very high. And then the last thing I'll say is we have, happened to have a pretty strong Latina design team. Based here in the US in particular, our Mexican American designer, Danny. So there was a lot once we got our feet on the ground, a lot felt right, but when we submitted it had no idea that we would now spend what was, you know, nine months of pretty constant engagement in Tucson.
And I will say Tucson isn't that easy to get to from New York. It's like a handful of cities where no matter what regional carrier you look at, there are no direct flights. So we weren't totally prepared for kind of what, what a journey it was, physically and mentally and emotionally to sort of land there.
And uh, yeah, fortunately we had just such strong belief as you can tell, that the process would lead somewhere, that that belief was able to carry both some of the stakeholders inside government as well as some of these community partners, carry them along until they started to experience the process.
And I think then, you know, there was a lot more trust that emerged pretty quickly. But initially, you know, as Adrian very clearly put, There wasn't a lot of clarity on where this was gonna land and that, and that's hard. And that was doubly, because it's both a design process and also, you know, the grant was made at a time and place relative to the pandemic and time had passed. And so we went in knowing that this was not an easy issue to use to drive health behavior. It might have been 18 months ago.
Bon Ku: it, it was a lot like chasing a moving target during the pandemic cuz that's how fast the virus was moving and that's how fast the landscape around public health was always changing.
Adriane Ackerman: And how fast disinformation was evolving.
Bon Ku: Hmm. Adrian, walk us through some aspects of, of the program.
Adriane Ackerman: Hmm. So, We have a really, really diverse set of partners. So we have, there's three other, grant awardees in the state. So, Pima County here in Tucson. Yuma Maricopa, which most people may know as Phoenix and Gila Counties. So we set up a statewide learning collaborative to share best practices.
So that's one facet here. in Pima County we worked with, Two community based organizations, pep and Literacy Connects, as well as our Pima County Library System. And so those are all organizations that are focused on adult literacy and education for both rural and urban populations. We partnered with two different schools from the University of Arizona to comprise the evaluation component.
So we partnered with the University of Arizona's College of Medicine for the quality improvement kind of side of things at the MHC Healthcare Center that we also partnered with, and then the University of Arizona, Mexican American Studies department for more of the, the bulk of the qualitative evaluation. And then, like I said, MHC Healthcare. This is a, a healthcare organization in, Pima County. It's one of the oldest. They have locations all throughout the county and they primarily serve, you know, our population of focus, especially when it comes to their obstetric services. But they also are not like the big player in town.
They have never been the recipient of federal funding like this and have never participated in a program like this. And neither have some of our community based organization partners, you know, they're big players here locally, but this is their first time being stewarded through some of this type of process.
So brought them together, recruited patients from M H C healthcare, community members from those organizations. And then thanks to the stewardship of Dahlberg Design, really honed in on recruiting, folks within the community that were in this sphere of influence of those other people that I just mentioned. And then, walked them through the human-centered design process and had moments within the process where we paused to get the community-based organization's feedback, and really incorporate, you know, in an asset-based approach, what can we do with what we're learning. And what's developed as of right now is we're operationalizing two different pilots.
So one is, based within the clinics and we've introduced all these different, tools for practitioners and for patients. A Promotora led model, which is a community health worker model, but specifically delivered by folks who have lived experience within the Hispanic and Latin A communities and can relate and build that relationship of trust with patients throughout the process.
Trainings for practitioners. We're currently training like the full staff of two different large clinics on how to implement these processes and what they all mean and what health literacy is. And then also on the community side, our community-based organizations are taking the learning, you know, the findings from the human center design process and creating healthcare navigation workshops that allow for members of the community to learn how do I access healthcare in the United States, even if I've grown up here my entire life. What does it mean? What is the difference between an emergency room visit and an urgent care visit? How do I make that determination? How do I access resources? And then after this one time, class, they have the option to opt into a three month Whatsapp support group where a promotora, who helped lead them through the healthcare navigation class, is actually connecting them to resources that are pertinent to their development and maturity, in their own health literacy. So those are the two main components.
Bon Ku: I love that and I, when I hear you speaking, I could think of some of the work that you have done, Robert, with Dahlberg Design in other countries that, were there lessons learned from global health in other countries that you applied in the US?
Robert Fabricant: Yeah, absolutely. I mean, there's first of all, there's a global familiarity and then we've done some work in Mexico specifically. And so it was important to unpack that and I think one of the great learnings for us, and it sort of comes through both in as we look at the pilots we're implementing, but even in the design process, is unpacking what people are walking to the clinic with what's been their experience.
And that's often been shaped across the border. It's an hour away and the health system there has kind of evolved and found a different path, partly that structural, but found a different path than ours. And one in which there are some features that we see globally, but show up particularly there. I mean, one is that continued stronger trust and connection and availability and accessibility of, practitioners and physicians through channels like WhatsApp and other things.
So there's an a, a continuity to care that we've lost. We lost along the way and we're. Piece it back together with digital tools, telemedicine, with all these things. But the, but that trust is still there and people very often are, as they walk into a clinic like M H C, they're getting advice. And then they're also calling either directly, physician in Mexico or some family members to check both on the advice but also.
The availability and the cost. And it's not that that person has different expertise, but that person has a different time and relationship. And that comes back to what Adrian was saying. When you work in health systems that are much more under-resourced, you're constantly looking for what are these channels of communication?
Because the sphere of influence shrinks, right, in a highly under resourced health system in India or someplace else. The clinic itself, it sphere of in influence is very small. What gets touched inside the clinic versus outside is much less. And to some degree this is true because people in the communities we were, focused on are also kind of trying to navigate and make a lot of decisions that the clinical experience doesn't really. So we were trying to unpack that, you know, it was very confirming to know that there was a promatora like a, a health worker model, a volunteer one in place. And understanding how do you strike that balance. These people, on the one hand, aren't highly trained and aren't typically well integrated into the health system, but they have
Bon Ku: Hmm.
Robert Fabricant: Relevance as a peer in the community and that cultural knowledge, that lived experience knowledge is so lacking. So how do you get the health system to value that knowledge? How do you get them to be able to play a role that respects their connection? Allows for some of the variants that's gonna happen as they engage.
Supports that dialogue and conversation and uses it as, as sort of an on-ramp. And so that, that was a very interesting part as, as Adriane identified, you know, there are pilots running and being measured right now in the community and in the clinic, but one of the through lines is kind of a promatore type model.
and, you know, getting those folks to participate in the research directly. You know, and using them as a core constituency to test different ideas gives you a, a set of insights that you're not gonna get at either other end of the spectrum. So it was a huge piece of it.
Bon Ku: Now, how bad is the health inequity in this population? Do you have any stats of like, for those who aren't familiar, with the inequity that goes on in our country, despite us having a robust healthcare system and a very rich country, we have some of the worst health inequities, like on the planet really like in how bad is a health inequity in this population that you all were working with?
Adriane Ackerman: That's a great question Bon I was just gonna say that, Pima County overall. So if you're looking at a social vulnerability index, which is an index that takes into account a lot of different, living conditions, right? Access to healthcare, access to education, mortality from specific, chronic illnesses, et cetera.
We measure it in the United States on a scale from zero to one, where one is the worst and zero is the best. And overall in Pima County, our s v I is, I think, hovering around 0.8. This moment. So it was pretty high relative to the rest of the country. we also have a lot of other considerations that we haven't I think regionally we're still striving to develop the, nuanced approach that really captures the living conditions of this population because as Robert was saying, this is a population that in large part, even if they are you know, residents, whether with legal documentation or not of the United States, they're very transitory in the way that they see families seek healthcare services, et cetera.
And so they're kind of straddling a world that's across borders, and facing a lot of different, factors here, like this is a largely militarized zone, and I think that's something that's lost on a lot of people. We have a military base, we have border patrol, and they're, special provisions to be able to enact like, kind of, pretty extreme measures within because we're within 100 miles of the border.
and like I said before, I really mix political culture. So there are certain things that these folks experience that aren't adequately captured by even like the best metrics that we have. And it's why I think, bringing this kind narrative-based, human-centered design into the mix to address healthcare concerns has been so revelatory for us.
Like some of the things that Robert was just, touching on. I was surprised. I'll step back for just a second. My background. Has largely been in grassroots community organizing and coalition building and building those coalitions on the ground and in the streets, but also across sectors.
And I've only been in government both with the city of Tucson and now with the Pima County Health Department for about four years. And I, consider what I do here, practicing harm reduction. cuz I don't actually believe in these institutions, but I believe in our, collective capacity to overgrow them and to build dual power and build something different and better with the tools that are at our disposal.
And so I came in with, here with a certain perspective before we even brought, um, Dahlberg Design onto the project. We were kind of waiting for the R F P to go through and the contracting. And we were like, how can we reach people now? And we hosted, you know, the Pima County Health Department's first Spanish language town hall, and ours was on pregnancy and covid.
But it was, you know, I approached kind of the county, Infrastructure and said, okay, I wanna do this town hall in both English and one in Spanish with like Hispanic and Latin A practitioners. Yeah. And, and chat and tech support that are bilingual and it blew people's minds. Like that's kind of the relationship with this community that these organizations and institutions have been, have been working within.
Bon Ku: It sounds like the work you are doing on the public health interventions or just a different form of activism.
Adriane Ackerman: Exactly. Yeah. I found like my perfect nexus in public health. I wish somebody had told me years ago like, this is the career path for you. but when Dalberg design came in and exposed to us, you're dealing with a population. That is seeking dual care and those practitioners are not communicating with one another.
Bon Ku: Like, literally they're seeking care in two different countries, two different cultures.
Adriane Ackerman: Exactly. And those systems are not communicating with one another. And so there's a gap in that care and that kind of blew the lid off of things for us and allowed us to really start to examine.
You know, how do we pursue those relationships? I don't think it's anything that's gonna happen in the immediate future, but it's something that's allowing us as a department to reorient our work to community. And for that it'll have lasting, you know, just wonderful implications I think in serving this community and you know, serving my own bias in breaking down borders and their signific.
Bon Ku: Yeah.
Robert Fabricant: Maybe just to sort of build on that. I think it's, the insight runs deeply when you, talking to a practitioner and they start to realize there are things that this population prefers about the care in Mexico, and I say this, Mexico has a, fairly robust health system. But nonetheless, I think part of what we're trying to do is bring some of those positive qualities.
Into the way we think through this question of equity and trust and all the rest of it. And it's not just because they happen to be working across border. It's also that there are some things that are working quite well and some learnings that we, you know, that border wall, creates a lot of barriers and, and so that's, part of it is there's wisdom that's about how to deliver health well, how to deliver it with trust and meaning to people, even if you can't measure it. I can't say technically that the advice is better or worse in a given situation, but if the trust and meaning is there, number one, you need that trust and meaning to drive equity and literacy.
Bon Ku: Without it, you cannot. Number two, you are more likely to influence that person and for them to feel empowered, so it unlocks many positive. Tricky to measure elements of health delivery. how do you explain to someone about the role and value of design in public health and also maybe what are some of the limitations of design because I, I get asked this question a lot and I'm just kinda curious to know how, how you all would respond. For the listening audience, this may be a way to activate your local health department of, of, hey, either on the city, state, or federal level of the role that design can play in public health.
Robert Fabricant: Yeah, I mean I can offer a couple things that are, ground in this project and obviously I find it most inspiring when someone who's in the public health system like Adrian articulates it. Cause as a designer, I'm already kind of both converted and I, find it hard not to sing from the playbook a bit, but I think there are a couple things that show up pretty consistently as we think about that role.
the first thing is that it's important to recognize that it's a balanced role. We spent a lot of time with clinical staff understanding their experience. Today providers and clinical staff in, I'm not saying specific to, to anything on this project in general, are frustrated with the role they play.
They are looking for other pathways and opening up this, that space for collaboration within a clinical system is a powerful thing. It creates trust and belief. So I think that's, that's one of the first things that balances the dialogue. I think they come in and think, okay, well you're gonna start talking out to the community.
The community's gonna say they want all this stuff and we're not gonna know how to do it. And in a way, The bigger barriers and the bigger opportunities for change sometimes are within the health practitioners and in the environment. And for example, when we talked to 'em about bringing the promatores in, they were like, we've wanted to do that for years.
We just haven't known how, you know? So we were able to unlock spaces of opportunity that, you know, people when they ask this question, they always look for that example where you found some insight that was completely unknown and some, design change, simple design change that like boom changed everything.
And in a lot of cases you're just pulling forward things that people are sensing, but not knowing how to put a name and a word to. So I think that's the first thing. I think the second thing is helping them understand that design is a very data rich activity. You know, people in public health have strong leanings towards academia and social science. Their kind of preconception about design is, it's a very kind of quirky, creative thing. And so they'll create some space for it, but they won't always take it seriously. And so what we try and do is build our tools, learning agendas bring a lot of rigor to the early setup of research, so that they start to feel reassured. And that's doubly true when you have dollars like this that you're using, as a design firm, you have to respect that these dollars are hard won taxpayer dollars in this case, like no joke. You have to take great responsibility for the fact that you're collecting data, not just to serve your own creative process, but that should be benefiting a lot of constituencies.
And you know, that was one of the most powerful things about this partnership was Adrian had already put together in the team a great set of community-based partners. Those partners were in a regular dialogue with us. And they wanted to hear and learn about what we were learning. They had perspectives and ways to deepen those learnings, and we were consistently taking that information and synthesizing it into a set of tools and frameworks that made a lot of sense to everybody.
So, you know, in that sense, seeing that belief in the community partners also reassured the sort of government kind of stakeholders a bit as far as I know from the ones I interacted with. So I'm sure underneath all that, you know, there was a lot of continued need to push from, from Dr. Cullen and Adriane.
Adriane Ackerman: Yeah.
Bon Ku: the, from your perspective as a practitioner, what do you see as a role of design?
Adriane Ackerman: Yeah. So I think I'm just gonna double down on, on saying that I, I believe I'm trying to practice harm reduction from within government and sort use those dollars that Robert was just alluding to, to really truly serve the community. And so for me, given my background, you know, design really embodies the, at least when approached in this way, the idea of nothing about us without us.
Bon Ku: Hmm.
Hmm
Adriane Ackerman: that's not a practice or a praxis, that government is really, they haven't matured into knowing how to interact with community in that way, which makes a lot of sense. Government is in and of self. It represents a power dynamic that it's not conducive to that sort of level playing field and even valuing the opinion and lived experience and expertise of residents above their own.
So there's a lot of like different power dynamics that, Human-centered design can offer as a leveler, that makes the work of promoting equity and community-driven increased health outcomes a lot easier. And I will say, on a practical note, for other practitioners out there, there's a few different things.
So, I think it was in late 2021, early 2022. there was actually a federal mandate put out by the White House to increase the efficacy of, service delivery by incorporating explicitly human-centered design into programmatic development for federal government services, we were able to leverage that mandate and to really convince some of the folks on our, You know, the board of supervisors, our county administration, to get on board with this idea that lots of those folks hadn't been exposed to before.
and I think that's something people need to keep in mind. Like we have, to sway the opinion and bring people along with us in this process who are elected officials and are sometimes wary of new practices that they may not fully understand. It was a little bit of a meta, kind of like literacy situation.
We're practicing health literacy in the community and we're also like increasing literacy levels and awareness within our own administration and political leaders. I think that data is amazing, and I completely agree with what Robert said about the value that this brings to departments, especially in a way that they can quantify and, codify and really use as, good justification for the efforts for their funders and also we know that because of, how some evidence-based practices came into being within inequitable systems that just relying on evidence-based practices can be harmful to a lot of historically and contemporarily excluded communities. So I think design really straddles the two worlds of benefit in a way that provides political cover to get away with more innovative practices from within a bureaucratic setting than you would normally be able to. And I, I'll explain one of these, what I like to call kind of legal back alleys that I like to suss out as a harm reduction practitioner within government. Our county had a, a practice that I think is pretty universal with public health departments of compensating community participants at a rate of like, you've spent a couple of hours, or you take a survey, you get a $15 gift card to a grocery store, $25 gift card to a gas station or something. We worked with our lead human-centered design consultant who helped us to develop the R F P for Dahlberg design was Ilham Ali and I worked with her develop A market-based model of more equitably valuing community members lived experience and expertise.
And we actually got to argue and win approvals at the county and federal level to pay people a hundred dollars per hour for their time and involvement in these design processes. So we just like totally broke the ceiling for government compensation and, I feel like I shouldn't even be saying this on an international podcast, but we built in, in plain sight a restriction that we would not pay people more than $599 per calendar year because as someone who grew up in the system and lived off of government benefits for a large part of my life, I know how much that kind of extra boon above the tax reporting threshold.
Can endanger your access to services. And we got approvals at the county and federal level for that and built an entirely different model that we've been able to share with other, awardees of this, grant process and kind of proliferate throughout the nation. And we're hopefully like moving the needle on that.
But we wouldn't have been able to do that if we didn't do it under the the umbrella of the expertise and the approach of using human-centered design. You know, we said we're, we're bringing people into this highly personal experience that could be extractive if we don't value and honor them in this way.
So that was huge.
Robert Fabricant: Just to build on that. I do think coming to the last point, Adrian made, because we're bringing people into a collaborative space and not just doing a simple interview, it gives us permission to say the value exchange is different because they're gonna come here, we're gonna build, we're gonna create, we're gonna, engage them And draw out of them different value. And so that creates, opens the door a little bit to rethinking that equation. We are seeing this a little bit more globally. There are some other funders we work with that are starting to define lived experience experts on the same level as technical experts and look at both their time and their voice in the same way.
So I think it's a growing movement, but it's one thing to look at it philosophically, and it's another thing to then put pen to paper, do the math on it, because it ended up being a very significant part of the project investment. And then to sort of figure out, well, how do you get everyone comfortable with it?
Not just signed off on it, but but comfortable with it. Yeah.
Bon Ku: There's so many rich learnings here. I could talk all day. We're running out of time. I have two final questions. Maybe you can share one final takeaway around design and health equity. And my favorite question is, if a listener were to come visit you, where would you take them out to eat? So let's start off with you first.
Adriane Ackerman: Oh, thank you. I would say my takeaway builds off of the last question. Again, using human-centered design and being able to report back on, we're just now operationalizing the pilot phase, but there's already been so many rich learnings that it has allowed us as a department to justify moving toward an initiative to train our entire upwards 400 employees in human-centered design practices. Yeah. So we're doing that this Summer. We're gonna train everyone on human-centered design so that all of our programs can be developed, centering the voices of the folks that we're seeking to serve. That's huge.
And we were able to do that based on the efficacy of one program. So if there's anybody out there wondering if they have the capacity or maybe need any advice on like how to build the support? I would love to connect with anyone and help you understand how I kind of rabblerouse from within in a way that brought these, these efforts into play.
Bon Ku: And we'll put your info in the show notes as well, so listeners can reach you. So thank thanks for sharing that.
Adriane Ackerman: Yeah, absolutely. No, it's my favorite. I'm like, let's do it everywhere, please. And then if you want to meet and talk about that in person in Tucson, Arizona, if you were to visit me, I would take you to one of the restaurants that I've taken Robert to when he and the Dalberg design team have visited, which is La Indita. So La Indita is, they're actually just recently visited by Bernie Sanders and a couple other prominent folks, but it's a family-owned business. They're one of the oldest restaurants in town, and they deliver specifically Sonoran, so we're in the Sonoran Desert, so this is like Sonoran food. This cuisine is amazing. The atmosphere is so friendly. They have an amazing patio. It's just always the best experience and they're super affordable.
Bon Ku: Robert, how about you? It's gonna be hard to follow that up.
Robert Fabricant: Hang on. First I'm gonna tell a quick story that leads into sort of a take my main, one of my main takeaways. So when we first went out, Danny and I, just to get to know Adriane and the team, we did um,kind of a mapping exercise of the values and principles we were trying to take to the project.
And then we did a last where on a sticky note, you draw and describe a moment in your work that you felt started to embody those values. And unsurprisingly, Danny and I were both kind of sharing moments that were very. In a moment. We were in research. There was Mexico or someplace else and, and, kind of coming to this point of deep realization and understanding of someone's experience, but it was in a situation with two three of us and then Adrian shared her sticky and she was talking about a moment when she organized, you tell me how many in Portland, Oregon 10,000, 20,000 people. I was up on the stage speaking to them and feeling that emotional connection. And I never totally told Adriane but on the flight back, we were just blown away. And it kind of comes back to a little bit of a, sort of bridge on what Adriane spoke about.
if you take it and it's, it is a generous compliment and think that design is good at creating this power leveling space. The question is, how do you do that in scale across communities? A community is diverse as Tucson, and I feel like there are kind of lessons and learnings and models of community development that I'm only pulling the threads of from Adriane on this project.
But I feel like there's always been a connection between design and advocacy. Like you want to change hearts and minds. You wanna create the, the sort of movement, like design plays a role in how you, kind of create the brands and the language and the messages, the symbols to drive movements.
But this other layer of true community development longer term and where design plays in that to me is like the puzzle that's come out of this project that we're thinking about a lot across
Bon Ku: Yeah, I love.
Robert Fabricant: All right on food. I don't know if you know Bon my mom writes about food for the New York Times.
So we rarely go to the same restaurant twice. Very unusual that I'll go someplace more than once. But I will mention a place in my neighborhood in Brooklyn. It's called Le Succulent, and it's one of the first West African restaurants that moved into, into a world. You know, I, partly cause of my mom, partly growing up in New York, like I experienced a lot of very diverse food my whole life.
But West African food is arriving and it's run by a couple. So the service and the food comes very slowly. And I've eaten West Africa food in West Africa, so I know what I'm up against. But the quality is great. It's a very sweet, friendly family one place. And if you haven't ever had chicken or fish yassa, jollof rice, like in a proper like loving, tender environment, like you'll get it there on Fifth Avenue in Brooklyn.
So it's a taste of, of a world that I hope we'll all get to experience more because the food is incredible in that region, and yet it hasn't had its, you know, its moment to kind of spread in the way it should.
Bon Ku: Well, listeners, we're gonna put links to both of those amazing restaurants in the show notes. Robert, Adriane thank you so much for sharing about your learnings, the role of design for health equity. This is, uh, amazing. Was so inspired by this conversation. Thank you.
Adriane Ackerman: Thank you so much, Bon, and I just have. Robert, when you had me order for you at La Indita I knew you were a foodie, but I didn't know you were like progeny of New York Times level foodie, and so no wonder I felt so much pressure to deliver with that food order, but I'm gonna take you up on some of those offers when I, visit in New York.
Robert Fabricant: Well, it was a great introduction to Sonora Food, so do not worry. Normally when I visit someplace, my mom gives me a rundown, like, you have to go here, here, here, here, here, and here. And she'll call if I don't go to make sure. I went here, here, here, and here, and it was green field for me, Tucson.
Adriane Ackerman: But yeah,
Thank you so much. Fun.
Robert Fabricant: Thank you.
Bon Ku: Thank
you.
You could find Robert on Twitter at F a b t w e e t, and you could learn more about Adrian's work in the show notes. Rob Pugliese produces Design Lab editing is done by Fernando Quieroz, Emmanuel Houston created our theme music, and the cover design was done by Eden Lew. See you next week.
