Health in America is a Wicked Problem

Jan 20, 2016 | Stakeholder Health Reflection | 0 comments


By Tom Peterson

In 1973 Horst Rittel and Melvin Webber, two U.C., Berkeley professors, published a paper describing Wicked Problems. They said that the traditional scientific approach doesn’t work in solving social problems. Problem solving in the industrial age focused on efficiency, and the challenges our scientists and engineers address are similar. They all focus on “tame” or “benign” problems such as solving a mathematical equation or analyzing the chemical structure of an organic compound. For these, they say, “the mission is clear. It’s clear, in turn, whether or not the problems have been solved.”

A wicked problem is one that’s not easy to describe, it has many causes, it’s hard or impossible to “solve.” It’s occurs in a social context where diverse stakeholders understand it differently.

wicked-problems4-300x225“Fixing” health in America, a wicked problem

Explore what’s involved in health in the United States and you’ll quickly find yourself tangled in a web of issues. Often referred to as “social determinants of health” they include poverty, lack of education, substandard housing, unsafe neighborhoods, and so on. But that’s just the beginning. As you dig deeper (wherever you’re digging) you quickly discover the complexities.

“Poverty is the swamp,” said William Clapp. “It doesn’t create all the problems, but it’s the sticky goo you’ve got to wade through to solve anything, whether it’s environmental problems or political instability.” The health issues in my town and yours are related to poverty. And I believe the root of poverty is the lack of democracy. It’s about people’s ability to determine matters that impact their lives. So now we’re into issues such as voting rights, political influence, grassroots organizing…. Add to that who controls city planning, who controls the media, taxes…. These themes play out even more dramatically on the state and national levels.

That we all view the problems and connections in our peculiar way adds to the wickedness of the challenges in creating a nation of healthy people.

It’s all connected

Pull on a single thread of any wicked problem and you quickly discover you’re pulling many, many threads.

wicked-problem-3-300x225“Imagine a multidimensional spider’s web in the early morning covered with dew drops,” says Alan Watts. “And every dew drop contains the reflection of all the other dew drops. And, in each reflected dew drop, the reflections of all the other dew drops in that reflection. And so ad infinitum. That is the Buddhist conception of the universe in an image.” It’s also what a wicked problem can look like. Each piece reflects and connects to the others.

Ten Characteristics of Wicked Problems

Horst Rittel and Melvin Webber presented the ten characteristics of wicked problems:

  • There is no definitive formulation of a wicked problem.
  • Wicked problems have no stopping rule.
  • Solutions to wicked problems are not true-or-false, but good or bad [or better or worse].
  • There is no immediate and no ultimate test of a solution to a wicked problem.
  • Every solution to a wicked problem is a “one-shot operation”; because there is no opportunity to learn by trial-and-error, every attempt counts significantly.
  • Wicked problems do not have an enumerable (or an exhaustively describable) set of potential solutions, nor is there a well-described set of permissible operations that may be incorporated into the plan.
  • Every wicked problem is essentially unique.
  • Every wicked problem can be considered to be a symptom of another problem.
  • The existence of a discrepancy representing a wicked problem can be explained in numerous ways. The choice of explanation determines the nature of the problem’s resolution.
  • The planner has no right to be wrong (planners are liable for the consequences of the actions they generate).

wicked-problems-300x225Affordable quality health care in the United States is a wicked problem. So are economic disparity, racism, women’s rights, homelessness and so on. As is any fractal piece of any of these. Mahatma Gandhi didn’t completely “solve” his challenges of both independence and convincing Indians to live in harmony. Martin Luther King, didn’t solve his challenges. Neither have Gloria Steinem, Caesar Chavez, James Grant or Malala Yousafzai. They all took on extremely wicked problems. And we live today in a better world because of their work. Hope and progress lie in the struggle forward.

Wicked Problems Links

Spider photos in order (all from Creative Commons): Mharti, Luc Viatour, Thisisbossi, Thomas Bressen.

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