Tackling Poverty with Design Thinking
I listened to this fantastic story on NPR last week, which featured Maurice Lim Miller, who runs the Family Independence Initiative (FII), a nonprofit here in San Francisco that helps families tackle poverty. He created the FII when Jerry Brown (who was the mayor of Oakland) gave him the opportunity to do anything he wanted to do to address poverty, and he had just a few weeks to come up with a solution.
“He says that…he wracked his brain, but he realized he didn't know the answer. Then it dawned on him: His mother was a poor Mexican immigrant, and she had somehow figured out — on her own — how to get him out of poverty.” So, he told Brown, why don't we take the money and pay poor families to show us what they would do?”
Through this revelation, Lim created the FII, which at its core, recognizes that the experts in poverty are the individuals who live in poverty. The program taps into that expertise, and empowers the families to find support and solutions to improve their situation.
What is unique about this program? Families are in charge, instead of the social workers. A family who participates assembles a small group of peers that meets on a regular basis to share ideas, resources, and advice, and to hold each other accountable. Families are also required to collect data on a regular basis, logging onto an online journal to input and update information such as income, savings, health, education and housing, as well as their leadership and networking participation. For this effort, families receive an average monthly stipend of $160 and a laptop computer. They also get feedback from the online journal: a picture of their progress over time with graphs of their income and savings.
It’s still a pilot program, but it seems to be having impressive outcomes, including an average 20% increase in income over 2 years and higher school grades and homeownership rates and savings.
As Lim says, “We trust that as a group the families have the knowledge, initiative, and the capacity to lead themselves. Our process just catalyzes this potential.”
What a revolutionary approach for tackling poverty. So why can’t we do something like this to improve adherence and outcomes in healthcare? Our patients are the experts of their own diseases and their own lives. Could health systems find a way to engage them in their health and healthcare in a more participatory way, to enhance and improve upon more top down institutional approaches to chronic disease management? Can we take the plunge and trust our most important users, just like Lim and his colleagues did?
