Improving Equity in Products: Humans Know the Way

May is Mental Health Awareness month, and after a year of a pandemic which brought deep suffering to the world and laid bare the deep inequities in our culture, we are in the midst of a second pandemic of mental health suffering. Women left the workforce in never seen before numbers, to care for and teach their children; Essential workers, far more likely to be Black and Hispanic, risked exposure and ultimately died in record numbers just trying to keep their families afloat and our economy moving. The loss, grief, anxiety, fear, and anger that naturally arise from this tragic year are meeting the lack of mental health resources available in our country. We are still suffering.

Knowing the stakes are high, and the system fractured and fragile, how can those of us in health technology use our work to improve equity, representation, and ultimately, the lives of those we create for? This question was posed recently when I was on a panel for a Women in Technology summit. The answer I, as psychologist and product designer, turn to over and over is that the humans we create for know the way. By centering our users, by being inclusive and seeking diverse points of view, by knowing we are not reasonable proxies of their needs but only amplifiers of their voice, we make change possible.

Design Thinking approaches problem solving from the frame that the end-user is the expert, not the designer or the CEO. From that stance, research becomes required because how else can you gain the expertise needed to create your product? From idea vetting to feature desirability to usability, users guide the development process. Couple this process with Systems Thinking, which embeds a product in a larger context, social and societal, so that multiple stakeholders can be identified, and conflicts can be understood and worked through. Seeing how systems interact, highlights that a product, meant to increase the convenience or safety of one group, can also cause harm to a different group. Good intentions of Design Thinking are not enough to reach societal equity without Systems Thinking.

Our current Mental Health access crisis is not new but is deeply exacerbated by the COVID tragedies. Health tech has attempted to increase access to counseling via apps that facilitate text and video sessions with therapists. Increasing the ease of access to therapists a crucial step in providing support to all who need it. Looked at from a Systems point of view, however, therapists themselves are a stakeholder group. There are not enough counselors to treat people because we have not invested in access to education for mental health. This is especially true for low income or minority students who are not able to afford the cost of college and a master’s degree. In addition, the pay can be very poor. In a world of high education debt, entering a field with low economic reward can be foolish. The apps exacerbate this care shortage by bringing in low-experience, low-paid coaches to drive down the cost and compete with local practices. Solving the access problem that was created over decades will take multiple investment streams from government, education, and the private sector. Health tech can’t do this alone.

Innovation, with empathy and advocacy for all stakeholders, is how we begin to make progress. I take our mission seriously. Helping people make smarter healthcare decisions means understanding the ways people decide where and who to go for care (design) and understands the barriers and traps inherent in our system of care (systems). Our team uses that combined understanding to design features that guide people, make options visible, and connect the scattered (and confusing) parts of getting care. We seek to be guided by the humans we create for, all of them! We also know that our tool isn’t used in a vacuum; we need to understand the impact of presenting information on the providers themselves. Can a feature that makes filtering by provider physical attributes, intended to help members find providers who they can relate to, in fact, harm the physicians? What is the way we facilitate matching patient and provider so that both are honored and respected? We can only approach these product feature questions through open inquiry and humility. We have to ask and listen so that we are not solely data-driven but human-centered.