Public health informatics: What’s the problem?

My earlier blog details the findings from the audience assessments, but to put it simply, we learned that public health informatics has trouble making itself visible. Our field has trouble getting the message through.

Why? Experts have the background and language to communicate well with each other, but a broader audience—even within public health—has key gaps in understanding and won’t know how to fill in the blanks.

In all fields, according to the FrameWorks Institute, experts react to people’s misunderstandings by overloading their audience with more information. They make more lists, add more jargon, and throw in some data, hoping that this will lead to an epiphany.

Throwing more data at a problem just doesn’t work. Instead, a more successful strategy is to proactively frame a topic in a new way to enhance understanding.

The power of metaphor

For this project, FrameWorks immediately knew that explanatory metaphors would be crucial for filling in cognitive gaps. Metaphors are effective because they use people’s everyday knowledge to help them understand how a new concept works.

FrameWorks developed three metaphors, and these form the foundation of the toolkit. These metaphors compare informatics to:

• Information architecture
• Information translation
• Data logistics

Here are the ideas behind the metaphors:

Architecture

As information architects, informaticians are responsible for designing and building the processes and systems that enable public health professionals to do their jobs. Just like architects plan buildings to be safe and comfortable for the people occupying them, informaticians plan information workflows and systems according to the needs of all users.

Translation

Public health data come in many languages and informatics is a translation discipline. Informatics bridges differences in vocabularies that might otherwise inhibit effective communication and the reuse of information. Informaticians also bring together groups of people who may be new to working together, such as connecting clinical care to public health. In this way, informaticians know how to “speak the language” of different people, such as clinical providers, health care administrators, software programmers and other IT professionals.

Logistics

Last, informatics as logistics. Just like the complex systems we depend on to send and receive packages on time, informaticians design the complex systems that ensure people get the public health data “packages” they need, quickly and efficiently. Informaticians analyze the data senders, recipients and the possible transport options to help ensure that the data—just like the packages—aren’t intercepted or damaged, and that the data are delivered securely.

You’ll notice that each metaphor does different work, so you can choose the one best suited for your communications goal. The metaphors are not intended to be complete definitions by themselves. They’re an opening you can use with a broader audience, to begin bridging gaps and developing an understanding. Once your audience has this understanding, you can fill in more details.

Applying the metaphors

The metaphors can be applied for many different formats and uses. Here’s one example of how informatics can be redefined using the idea of architecture.

Standard definition:

Public health informatics is the systematic application of information and computer science, as well as information systems, to public health practice, research and learning.

This is fine definition, but it appears to have been written by experts for experts. While experts have the knowledge and background to make sense of this definition, the non-expert does not.

Revised definition:

Public health informatics is a field that designs the blueprints for the complex data systems that keep information secure, usable and responsive to public health’s needs. Informaticians are knowledge architects of public health—the information systems they build account for function and local contexts.

This definition builds on the idea of architecture—a concept that a broader audience is familiar with—and cues the mental image with the underlined words above.

In the toolkit, you’ll find many other examples and applications such as talking points, elevator speeches and infographics.

A house on fire

To close, this story from Bill Foege’s autobiographical book “House on Fire: The Fight to Eradicate Smallpox” effectively conveys the power of a single metaphor.

In his book, he recounts the grave smallpox situation in Bihar, India. After much work toward a surveillance/containment strategy, the minister of health wanted to revert to a mass vaccination strategy. He remained unmoved by the smallpox eradication team’s pleas and their evidence that departure from Dr. Foege’s ring containment  strategy would set their efforts back substantially. However, in a meeting with government officials and field workers, a young physician stood up and humbly addressed the health minister, saying if a house is on fire in a village, no one wastes time putting water on other houses, just in case the fire spreads. Instead, as in the surveillance/containment strategy, the villagers rush to pour water where it will do the most good—on the burning house. After hearing this, the minister of health suddenly changed his mind and allowed the containment strategy to proceed—eventually resulting in the first disease eradicated through human efforts.

Despite all the work the team had put into persuading the minister of health with facts and projections, only the image of a burning house convinced him to stick with the containment strategy. Today, we live in a smallpox-free world—and we have a powerful metaphor to thank for that.