My first Nokia cell phone lasted for five years, and would’ve lasted much longer, but those new flip phones were so cool, I felt the need to upgrade. And that flip phone lasted me a good two or three years, but then the iPhone was released, and I couldn’t resist. Now a new iPhone comes out every year and I’m lucky if I make it that long without dropping mine and cracking its screen. The timeline for change and innovation has sped up so much over the past couple decades that it can feel like we’re on a high speed train moving too fast to even see the scenery blow by.
These days, being known as an innovator is some of the highest praise one can receive. Whether it’s a new technology, a new addition to the “sharing economy,” or an advancement in medical care, innovation surrounds us. More often than not, we only talk about the myriad benefits they bring society. However, it’s just as important to examine the potential negative effects. This phenomenon—when innovation leads to unintended consequences—has been coined innovation “bite back” by sociologists, and calls into question the fundamental assumption that our best innovations only contribute to societal progress.
An excellent Wall Street Journal article (search “innovation bite back” in your browser for access if the link doesn’t work) laid out a number of health care examples that I found really interesting. The cultivation of sugar beets led to an increase in sugar consumption, which resulted in increases in obesity and tooth decay. Lead was added to gasoline to improve performance before we knew about its detrimental health effects. The proliferation of antibiotics has led to dangerous levels of antibiotic resistance.
Still though, it seems that most everyone believes that innovation must play a key role in building a better health care system than we have today. Indeed, various entities—from government agencies, to philanthropy, to the health care sector itself—have recently poured millions of dollars into health care innovation through grant making, innovation challenges, and hackathons.
This year, CCMU has been working with partners to explore ways to bring the social determinants of health into the health care setting—to identify patient needs and then connect them with community resources like food assistance or housing. There are a number of pilot programs that have shown great results, so it’s an attractive idea to hospital systems and health care agencies nationwide. A close partner recently pointed out that the health care system is perhaps the most complex and expensive system there is; while the work of connecting individuals to community resources that can improve their health is critical, is the health care system really the right place for it? What would happen to trusted community-based direct service organizations if health systems create duplicative systems? Since people only touch the health care system periodically throughout their lives, could a cheaper, community-based social screening infrastructure be a better approach?
We don’t have the answers right now, but the important lesson here is that we have a responsibility to identify and evaluate the unintended consequences before we embrace another innovative approach. As innovative ideas, products, and technologies continue to emerge, pointing a critical eye toward potential unintended consequences, especially ones that could negatively impact vulnerable patients, is necessary, if we want to ensure we are actually creating healthier communities. And maybe I’ll wait on that new iPhone 7; it doesn’t take a critical eye to see that the lack of a headphone jack isn’t ideal!