The social side of innovation

Starting in 1979, BRAC revolutionized the prevention of diarrhea (the leading cause of high child mortality in Bangladesh) by establishing its Oral Therapy Extension Program and reaching every household with the preparation of home made saline, as pictured above, c. 1979. (Photo: BRAC)

Atul Gawande’s recent piece in the New Yorker, “Slow Ideas,” is a must-read for anyone interested in social innovation or figuring out how to spread efficient (and sometimes life-saving) solutions to difficult problems.

Gawande, a surgeon, public health researcher at Harvard and author of The Checklist Manifesto, has been exploring why some innovations spread fast and others don’t. The author takes an in-depth look at BRAC and its usage of oral rehydration solution to combat childhood deaths from diarrhea in the 1980s.

While the article comes at the idea from a healthcare perspective, I think we can all find a valuable lesson in the illustration of the undervalued role of social networks in spreading simple, cost-effective innovations.

Stalled ideas tend to attack problems that are big but invisible – deadly hypothermia in newborns, for instance – and making them work can be tedious and sometimes painful, Gawande writes.

When tackling big but invisible problems, the best approaches tend to get people talking, one on one. Solutions ultimately succeed when social networks change social norms.

“Slow Ideas” uses the example of the seemingly intractable problem of diarrheal death. In 1968, The Lancet, an esteemed medical journal, reported that oral rehydration solution, a solution of sugar, salt and water, could prevent death from dehydration in children with diarrheal illnesses like cholera.

Despite the findings, the solution failed to catch on quickly.

A decade after the landmark findings, the idea remained stalled. Nothing much had changed. Diarrheal disease remained the world’s biggest killer of children under the age of five.

In 1980, however, a Bangladeshi nonprofit organization called brac decided to try to get oral rehydration therapy adopted nationwide. The campaign required reaching a mostly illiterate population. The most recent public-health campaign—to teach family planning—had been deeply unpopular. The messages the campaign needed to spread were complicated.

Nonetheless, the campaign proved remarkably successful. A gem of a book published in Bangladesh, “A Simple Solution,” tells the story. The organization didn’t launch a mass-media campaign—only twenty per cent of the population had a radio, after all. It attacked the problem in a way that is routinely dismissed as impractical and inefficient: by going door to door, person by person, and just talking.

The details make for a fascinating case study of how life-saving solutions, even tedious ones, can be scaled up. “The knowledge became self-propagating,” Gawande concludes. “The program had changed the norms.”

Between 1980 and 2005, child deaths from diarrhea fell more than eighty per cent in Bangladesh. As other countries have adopted the same training procedures, deaths from diarrhea have dropped from five million a year to two million.

Changing norms through people interacting with people is the same conclusion that Molly Melchang came to in her pioneering work with Tostan on ending female genital cutting in Senegal. Aimee Molloy’s recent book However Long the Night tells her story – a great book that was on my summer reading list.

Gawande can be also be seen on the Colbert Report discussing his article here.

Read “Slow Ideas” in its entirety at The New Yorker.