17 Nov The Emotional Starting Point: Access To Health Care
When you read about the barriers to health care access, the usual suspects are: Lack of access to a health care provider, lack of insurance, and financial burden of health care cost. Other research also points to social and cultural elements like language and health literacy. However, very little research explores the emotional dimensions that impact access to health care.
Our analytical thinking has brought about unforeseen advances in science, health and technology. And yet, our intellectual prowess has not successfully cracked the systemic social problems we face in our society. The success of the scientific approach reinforces the story that we human beings are thinking creatures that feel. Yet, as neuroscience (Jill Bolte Taylor – My Stroke of Insight) and behavioral economics (Dan Ariely – Irrationally Yours) show us, we are feeling, irrational creatures that think. A helpful metaphor to help us see the relationship between our thinking and feeling aspects is to imagine a person riding an elephant, where the rider represents the thinking element and the elephant stands in for our emotional states (This metaphor was originally, described by Jonathan Haidt’s, a professor at NYU, and then expanded upon by Chip and Dan Heath in their insightful book Switch: How to Change When Change is Hard ). Behavioral change requires engaging both the rider (thinking) and the elephant (emotions). And yet, most solutions to solving access to health care seem to be speaking only to the rider. While it is important to direct the rider, we must motivate the elephant.
Hope, fear, pride, shame, anger, and others, are emotions that can impact whether we seek help, what kind of help we seek, and how we communicate our health care needs. We need to engage emotions if we want to support people in accessing health care. Knowing where the services are, and how to get insurance work only if we are able to engage people at the emotional level; this is especially true for communities that historically have been disenfranchised. That is why we are seeing great success in the role of “promotoras," like the ones being used in Latino Health Access, and the role of patient navigators. These “promotoras” and other patient navigators help build trust and engage the emotional elements that prevent people from accessing services. By starting with the emotions and building empathy, we are able to “…engage how culture, racism, and history influence initiatives and their evaluation.” - Nayeli Y Chavez-Dueñas & Hector Y. Adames.
In her book, Meaningful: The story of ideas that fly, Bernadette Jiwa, re-imagines Maslow’s Hierarchy of needs from the perspective as to what customers would want from a product and services. At the base of the pyramid you find things like “Product, service, platform, access” (My italics). In the next level up you have “functionality, equality, experience”, that is followed by “Relevance, responsiveness”, and at the very top you have “Empathy”. When we think about access to health care, we need to think about the barriers in terms of infrastructure and cost, and we must also listen to the emotions embedded in the stories we listen for the people we want to help access health care.
Methodologies like human-centered design and social labs also have a lot to offer to this emotional dimension. Human-centered design starts with the emotions. The needs of the user emerge as we listen empathically to them. The emotions that come out of this process are noted and seen as gold nuggets rich with valuable information. The emotions are not some afterthought, but rather a starting point. There are of course other considerations, like usability and viability, but the design process starts with empathic listening and emotions. Social labs, a new approach that looks to tackle complex challenges over time with diverse stakeholders, takes a systemic, experimental approach to testing solutions that emerge. This approach is being used to help change the user experience when visiting a doctor in Flip the Clinic; however, there is a great opportunity to use this approach in prevention and increasing access to health care.
So how might we support each other in keeping in mind the emotional elements that prevent access to health care? How might we support each other in listening for the powerful insights that can emerge when we pay attention to our emotions and the emotions of others? What emotions does this piece raise for you and what meaning do you make of it?