Pushing the Edges of Public Health

Nogueria was recently honored with the 40 Under 40 Public Health Catalyst Award from the Boston Congress of Public Health, which recognizes emerging leaders who are working toward a more equitable world. With a polymath background in urban planning, geography and architecture, Nogueira has already led a considerable number of projects around the world in both cities and rural settings like the Amazon basin in Brazil. Nogueira says what unites this work is a deep commitment to sustainability.

Whitney and Nogueira were drawn to public health due to its use of data and statistics, offering insights that the designers could leverage in their work. They also saw the ability of design, with its focus on human behavior and the user experience, to make health initiatives work better for people.

“Design can improve public health by creating solutions to problems even if we might not fully understand why those solutions work,” Whitney said. “Public health often deals with complex, data-rich problems. Our approach is to solve these problems and then collaborate with public health scientists to understand which variables matter the most.” 

Nogueira adds that tackling public health problems requires the involvement of multiple parties, each with their own interests and perspectives that can influence the success of an initiative or intervention. This includes doctors, community members, academic institutions, policymakers, and private companies, working independently but aiming for the same public health objectives. 

“Let's take the example of improving access to healthy food,” Nogueira said. “Farmers might focus on land and soil quality, while transportation experts highlight infrastructure needs. Cultural and dietary habits also come into play. The challenge is getting all these diverse voices on the same page and fostering productive discussions among them.”

In public health, he added, “it's not just about individual products or services; it's about understanding the relationship between them in the context of people’s lives and designing more holistic solutions that work at the intersection of multiple systems shaping everyday activities.”

From Mass to Flexible Production

Whitney explains that public health and design have surprisingly similar origins. Public health became a recognized field in the 19th century when industrialization, urbanization and advancements in science led to organized efforts to improve the health of communities.

Over a century ago, public health efforts were directed toward providing clean water and preventing cholera outbreaks in increasingly crowded cities. As the field’s focus developed and changed, researchers turned toward preventing epidemiological outbreaks like tuberculosis and polio, which Whitney says, align with the “scientific and algorithmic aspects” of public health research. 

More recently, public health practitioners have widened their scope to cover areas like nutrition, diet, mental health and social well-being. “We now see the adoption of concepts like ‘social prescriptions’ for health, where doctors prescribe activities like going for walks with unfamiliar people or engaging in conversations about life stories,” Whitney said. “These activities are becoming part of health prescriptions, and we believe this expansion can continue.”

Similarly, the field of design as we know it today started to form around the 1850s, Whitney explained, when mass production and industrialization were on the rise. Designers assisted manufacturers in creating products that were not only functional but also visually appealing, ergonomic and efficient. “The aim was to produce items that could be used by as many people as possible, as it was ideal to minimize variations and target a broad audience,” Whitney said. “This was epitomized by Henry Ford’s famous quote, ‘You can have any color as long as it’s black.’”

But, as the 20th century unfolded, and manufacturing became more flexible, consumers sought personalized products. This shift towards what Whitney and Nogueira call “flexible production” was accompanied by advancements in computing technology, digital control systems and robotics integrated into manufacturing processes. “The move from an economy based on scale to one driven by choice is a significant transformation in our economic landscape,” Whitney said. “Choice was now a dominant force shaping the economy.”

Nogueira believes that the turn towards flexible production can be seen in modern, cutting-edge public health interventions. “Today, we have the capability to conduct diagnostic tests in the most remote and underserved areas,” he said. “Medical treatment can be tailored to an individual’s specific needs.”

For Whitney, we’re at a defining moment in the field of public health. “The forces of industrialization that gave rise to public health as a field are being challenged by a shift towards flexibility, speed and customization in problem-solving,” he said. “It’s not surprising that public health is changing; in fact, it would be surprising if it didn't evolve significantly.”

Current Projects

Whitney and Nogueira are busy. They are currently involved in six projects that apply design to social and public health issues, with approximately 20 more in consideration.

Last year, Nogueira led an award-winning initiative called Design for Social Prescribing. The goal was to use design methods to improve social prescribing in the US, which allows physicians to refer patients to social activities like volunteering or engaging in the arts for their wider health-related needs. This project resulted in a range of new actions, including prioritizing anti-racism in designing program evaluations, introducing social prescribing to state service commission and health insurance representatives, and forming new partnerships that bridge technical and policy expertise. Nogueira’s work was crucial in influencing the Foundation for Social Connection to adopt his models as a policy action guide. The initiative also sparked fellowship programs and a Harvard student-led advocacy group at four universities.

In India, Whitney and Nogueira are applying design principles to a range of socio-economic issues. Nogueira is leading a project focused on rural industrial parks in support of small and mid-sized businesses. Whitney is working to establish a tourism company that benefits small Indian villages, with a focus on social, economic and environmental sustainability.

“The scale of these projects is intriguing,” Whitney said. “One of our initiatives involves teaching government workers how to use design methods to develop solutions that are more customized and individualized. The potential impact is substantial: potentially benefiting anywhere from 25 million to as high as 80 million government employees.”

Whitney and Nogueira approach design by considering people holistically, aiming to improve their quality of life. “We focus on aspirations,” Whitney said. “Public health problems are seen as obstacles to achieving those aspirations. Design allows us to be optimistic because we’re constantly working to make life better.”