19 – The Holistic Interventions Principle

[00:00:00] Lucie: Hi and welcome to the IDEMS Principle. I’m Lucie Hazelgrove Planel, a Social Impact Scientist, and I’m here with David Stern, a founding director of IDEMS.

Hi David.

[00:00:17] David: Hi Lucie. I’m looking forward to another principle discussion.

[00:00:20] Lucie: So today we are going to talk about Holistic Interventions.

[00:00:25] David: Is this one you’re comfortable with or one you’re not particularly comfortable with?

[00:00:29] Lucie: No, I think compared to, Open by Default, I know a lot more, I feel more comfortable with this one. But I remember the first time I came across the word holism I just didn’t understand it at all. And I was like it’s missing the W! So we should say it’s holistic in the sense of looking at everything, I think.

[00:00:46] David: A whole rather than looking at components, yes.

[00:00:49] Lucie: And I still just find it weird that it’s spelt without a W, anyway. Because it’s whole! So this principle it, “applies [apparently] to company activities and it leads to an expectation that any interventions consider all angles and implications of implementation.” So yeah, coming to this whole with the W aspect.

[00:01:10] David: Absolutely, and I should be really clear, there’s different elements of this, it’s this element of intervention. This is a difficult term for me in many ways, but it’s something which I recognise is important to recognise, and that this is a lot of what we do. And it’s also, as you say, if you’re going to have an intervention, you want to be careful to think about the whole. And this is the element of actually thinking about holistic interventions rather than component interventions.

There’s really quite serious consequences to this. And it’s a hard principle to live up to. I’m not sure that we do, but we try.

[00:01:52] Lucie: So where does this principle come from?

[00:01:53] David: I guess it comes really from education as a discipline, where looking at holistic interventions is something where there is literature about this, there’s recognitions about why this is important and there’s recognitions of what can go wrong when you don’t.

[00:02:13] Lucie: Is that where the word intervention comes from too then?

[00:02:16] David: Intervention, I think that’s just a recognition that like it or not, a lot of our work is related to intervention. We really want to support innovation locally in different ways, but at the heart of the innovation that we support, it does relate to more global processes and global interventions.

[00:02:36] Lucie: And creating change.

[00:02:37] David: It’s not just about creating change. I would argue that there is an element of globalism, which comes in to intervention as a sort of, as a concept. Recognising that globalisation, I’ve seen real positives and real negatives from globalisation and the elements of intervention that are needed, really low resource environments, there are interventions which have been life changing in positive ways.

Obviously the medical field is one which jumps to mind where expectancy of life and this sort of thing have skyrocketed because of interventions in ways which are scaled across the world. And these have changed societies. They have often had negative as well as positive impact on society. But I feel health interventions are one of the real examples of why we can’t run away from the value of globalism. Reducing infant mortality, as has happened in the world, across the world, would not have been possible without interventions, and interventions have been extremely successful at doing that.

I find it difficult to critique, in any way, the reduction of infant mortality. It’s just something where, you know, having young kids myself, thinking about losing my children at age five or under is just unthinkable. And yet that was the reality for a lot of the world until quite recently. Look even just a hundred years ago, this was the norm everywhere. But, it’s been very recent in some sense, to really reduce that infant mortality pretty much worldwide.

The work is not done. But this has required global interventions. And it is part of how I reconcile the need for globalism and interventions from outside, whereas I really value local knowledge and the idea of sort of local cultures, so determining, creating that diversity, keeping their culture.

[00:04:54] Lucie: Yeah, but that’s where I know the idea of holisticism from, is from the sort of working with other cultures. And so that’s interesting that for you it comes in in the sort of intervention side and the holistic married to the intervention, it gives it a reason, or gives it legitimacy or something.

[00:05:14] David: I’m not sure it gives it legitimacy, but it avoids problems that have been observed. I will give one example from the health field, which is polio vaccine. There was a huge effort by the Gates Foundation with a very noble cause of eliminating polio, a horrible disease, which is very easily curable through vaccination in different ways. And so the effort to actually get rid of it as a disease at a large scale is something which was obviously desirable.

But, as I understand it, because of the implementation choices that weren’t holistic some of the negative effects of that effort were to actually make healthcare worse in difficult environments because they took healthcare professionals who were serving a wider role and led them to serving a narrow role. And because there wasn’t the capacity in those environments for additional people, this actually didn’t serve that community as well as it should have. Because the intervention wasn’t thought of holistically.

So I’m not going to dig into that example. I don’t want to really get caught up in any debates about it, but I do want to take it as an instance where thinking through the implications of if you’re going to divert people to do something, what are you diverting them from? That element of recognising that there are knock on consequences. If you do things at scale, there are really important consequences of where you’re recruiting people from.

In education, if you recruit a lot of really good teachers to be able to support an intervention, who’s teaching their classes? What’s actually happening to the teaching profession? Are there the people lined up ready for jobs to jump in and fill out those gaps? Or are you now creating imbalances in schools, which means that the quality of education is going down more because of the lack of those teachers, more than you are actually positively obtaining through the use of the interventions?

Now, that doesn’t matter if you have a handful of teachers out of tens of thousands. But it’s all about if you’re doing things at scale, and you’re looking at maybe something which actually becomes a percentage of teachers, which is a recognised percentage, then actually suddenly you need to worry about that much more. So it depends on whether you’re doing things at scale and how you scale things out. And these things need to be thought of holistically in terms of the system you’re creating.

And that’s sort of where this has come from and why this is so important. We are wanting to scale, we’re wanting to think about impact at scale.

[00:08:12] Lucie: So it’s partly a question of doing no harm.

[00:08:15] David: Exactly.

[00:08:16] Lucie: But I think there’s also a bit of sustainability in there.

[00:08:20] David: There are elements of both, but I would argue that in some sense, sustainability, there is another principle around that. So we shouldn’t confuse that in, in this context.

[00:08:31] Lucie: So to me something can only be sustainable if it’s holistic. So I’ve seen a lot of interventions which have been welcomed. The money’s there, but as soon as the NGO leaves, then people aren’t interested because they’re not receiving the support.

[00:08:46] David: Yes but there’s elements of that which, even taking a holistic approach doesn’t necessarily mean you’re thinking about things sustainably. But a good holistic intervention may not be sustainable, but you might learn a lot and you might understand the system better. This is related to systems thinking, of course, another of our principles, and being able to recognise that…

And, we’ve been hit by this over the years with efforts to work in schools, where I’ve had interventions which have been extremely impactful and really cost effective and so on, but they failed because they weren’t holistic. And let me just talk this through for a second.

Let’s say, and we’ve had this, let’s say you cover a small part of the maths curriculum. Your maths teachers aren’t interested because they say if I were to use this intervention there, then what about my other subjects? Now I’ve got to do different things for my other subjects. I don’t have the time to mix and match all these different things. I need something which can help me with all the things I’m teaching. So you’d need to get something in, you need to cover the whole curriculum.

And then you talk to the headmaster and the headmaster says yeah, I like this. It’d be great if you could help my maths teachers. But if I have an intervention which only helps my maths teachers, my other teachers get jealous. And so there’s all sorts of other issues that come in if you’re not taking into account other subjects, other disciplines. So the ability to actually do an intervention with just a particular subject becomes a problem.

And then of course you get to the fact that actually you have that intervention, who are you supporting? Are you supporting the teachers? Are you supporting the students directly? Or are you supporting the institutional structures? And somehow, unless you’re thinking about all of those in this, what are you doing?

And if you’re doing an individual institution or a set of institutions, rather than all institutions or the system as a whole, are you creating inequalities by where you’re working and how you’re working, or are you actually reducing the inequalities in the education system? What does this mean in terms of where people send their kids to school and so on? Are you creating other issues? What does this mean for access to education? What does this mean, in terms of the ability for people who are in low resource environments to be able to access these benefits? And so on.

So the levels of complexity that come in have been overwhelming. And a lot of what we started with, I was a great believer in doing things because you could do a lot locally at no cost, just by bringing in knowledge, just by bringing in small things and helping in small ways.

You can’t do a holistic intervention with no cost because elements of it will always need something which is more. So if you want to think holistically about something, then you have to think at scale in different ways. There’s elements of this where, as a, again, this is where IDEMS as an institution exists, partly because of this recognition to really have impact at scale we need to be able to be part of these holistic interventions which are able to be more ambitious, to be able to meet the demands of different actors, different stakeholders, so that it can become acceptable to all in ways which are challenging. And the scale of that can become overwhelming. I cannot claim to have been part of a single intervention, which I would consider genuinely holistic in an environment yet.

Even the parenting work, which I love to refer to, work with Parenting for Lifelong Health led by Oxford University. They are thinking about all these different dimensions and all these different ways across contexts, but within a single context, they tend to take a single component and say this is what needs to be worked on next.

And, this is a valid and this is a recognised approach to resolving wicked problems. Wicked problems being problems which cannot be answered immediately, they have complexity. There is a valid route to say okay, what is the next thing which is the right thing in that context to try and do, and then you go from one thing to the next, and you gradually try to do this.

Just to give an example, I love the example of, education as being a wicked problem. If you think about education in the UK this is a wicked problem because it’s not just: there is a particular intervention the government could do or anyone could do where suddenly from that point on education is fixed and you never need to worry about it again.

Now if you think of schools in the UK, yes, there are interventions you could do which would improve it. They would move the dial on where it is. But once you’ve moved that dial, there’s further improvements you could imagine. There’s always ways where you could always improve the system. You can think about what would happen next.

That would never just be finished, it would never be resolved. Education can just be improved. And so it’s a wicked problem because of the complexity and what you can do and what you need to do is think about from where you are now, how can I take a step in a good direction? And so holistic is not about getting to a utopian state.

That’s not what we’re talking about here. We’re talking about taking the current state and taking a step in a direction which we hope will lead to us being in a new state from which we can take other steps which will continue that positive process and lead to these virtuous cycles. But we’re never going to be there in a utopian state where this is sorted, it’s done, it’s perfect. There will always be need to consider to improve, that’s the nature of a wicked problem.

[00:14:48] Lucie: And is that also the nature of holistic interventions then, too, in a way?

[00:14:51] David: I don’t know, actually. I think, if you think about holistic interventions for a wicked problem, then you have to recognise that the interventions aren’t solving it. And therefore, they can be sequential, and you’re thinking about how those interventions should evolve over time, and should change, and should adapt as the needs of whatever you’re trying to solve goes. But I think you can have a holistic intervention for something which is not a wicked problem. And then that is something which is solvable.

So wicked problems are by definition not solvable. They are things where you can get positive virtuous cycles and get improvement on. You can move the dial on them, but they’re not solvable. That’s not the nature of that problem. But there are other problems which can be well defined and they can be solvable. And you can have holistic interventions for them as well.

[00:15:40] Lucie: So are there any challenges to interventions which are holistic? So far it sounds all good.

[00:15:47] David: It’s not as simple as that, maybe I need to be more balanced in this problem. And there’s a lot of criticism about holistic interventions and just the word holistic in education, which people feel sometimes means nothing. How is something holistic? Can you really…

[00:16:02] Lucie: Yes, absolutely.

[00:16:03] David: Well, especially because, as we’ve just said, in this context of wicked problems, you can’t actually solve everything at once. What does it mean to think about something being holistic when you obviously can’t do everything at once? You always have limited resources. So you can never, be holistic in the ideal sense. So what does it concretely mean? What value does it add? Is it just a nothingness term which people use because it sounds good? In general, is holistic unrealistic? Trying to be holistic, does that mean you actually don’t do anything which is of value?

If you take, specific intervention, which is well defined and where you can say I could do this, and you start worrying about all the other things related to it, then does it paralyse you and stop you from actually doing the steps which you can do right now and which could be useful? And there’s validity to that. I don’t believe everybody should be trying to be holistic.

And I guess part of this comes down to our role. Dealing with the complexity of a situation, thinking hard about it, that’s part of the role that we play, and that’s why we should be trying to be holistic. Often other people who are maybe more specialist at individual components, maybe they shouldn’t be trying to be holistic.

So I’ll just give an example now of your sort of school. So if I have an expert who’s really good at working with teachers, maybe they should only worry about what they’re really good at and their role in that. And the fact that you need to think of the institutional level things and the fact that you need to think about working directly with students and how that works in different ways, these are things which other experts can come in and play those roles.

So having experts who are specialists and who aren’t holistic necessarily in what they do, who are part of a team, makes perfect sense. It’s our role in the team, which is to think about the whole. This is the part of the role that we play. I absolutely believe in specialists. There’s real value to be had from people with specialist knowledge and understanding.

And often our role is to support such people. But part of that support is to challenge them to think of the whole, when maybe their expertise is to think of a component. And this is again, it’s about our role within, what we can bring given the expertise we have. We don’t tend to be those specialist experts, and we don’t want to be those specialist experts. We want to be thinking about the whole. We want to be thinking about actually, this is a great idea, but it’s not going to work because you have to think about that as well.

[00:18:49] Lucie: And I think you do that quite naturally too, anyway, don’t you? You not only think about this wider direction, but also you think about 10 steps ahead too.

[00:18:57] David: And a lot of this comes from experience. I have the fortune to have had experience seeing things evolve over time and to actually understand and have been part of what I thought wonderful initiatives, which got derailed because of those things, whatever they mean, and I can now bring that experience to the table. And because of essentially, and this is where I feel as an organisation where we have strength, because of the way we work across disciplines, across different areas, we can bring experiences not just from the domain in question, we can bring experiences from other domains as well. Yeah, this is really important and and I think part of the value that we bring.

Maybe one of the things that I’ll finish on, I’m conscious that we’re getting towards the end of this, but I do think it’s important to say that holistic interventions and thinking of interventions as being holistic is not something that I would recommend necessarily for all partners. So this is something which is, I believe, part of the IDEMS role within this.

So we work very well with specialist partners who are trying to do something specific. And part of the role and the value we can bring is to say, okay, you’re trying to do that. And we have some wonderful examples, even the McKnight work, which you’re so deeply involved in, which is very agroecology focused. I’m a great believer in agroecology in many ways. But looking at the problem more holistically, I’m glad there were people trying to do the agroecology bit. I don’t want to be limited to the agroecology bit. I think there’s value in value chains, in other components which people don’t associate to agroecology, in thinking about the labour market, thinking about what jobs are created, thinking about other parts of that puzzle, thinking about the rural environment more generally than just the agroecology component of it.

So I love working with partners who are embedded in their domains. But I really feel part of the value that we can bring is we are not embedded in a particular domain. And we can work across domains. And that’s part of where we can add value at different levels. And it’s something we need to guard ourselves against getting too sucked in to being domain experts.

We need to be able to play this holistic role looking at bigger systems. I’ll just dig into that example a little bit more. One of the reasons I love agroecology as an approach is I see it as a way which could support sustainable rural environments in the long term. But in competition with that is urbanisation.

And across low resource environments, urbanisation is happening very quickly and urbanisation has happened and is a big part of societies in a large part of the world. And in urbanised societies you have to have commercial structures because you can’t sustain yourself in an urban environment. You have to have these structures where you’re being extractive in some sense of rural environments where the food is coming out, and you need to then think about systems which then, actually work as a process with that as part of it. You can’t just think of your nice agroecological village sustaining itself, you have to think about how they sustain the city.

And this is something where urbanisation is one of the things which is in conflict, I would argue, with elements of the agroecological approach, which wants these local value chains. We have global value chains as well. Globalisation is important as well. And I don’t want to just think about one or the other. I value both.

[00:23:01] David: And so I really value and love working on agroecology and thinking about that and trying to dig into that and thinking about a future where rural communities are self sustaining and very, viable in their own rights. But I also want to think about and engage with processes related to urbanisation and the more urban societies, how these could be made sustainable in the future and what these would look like in the future.

We’re privileged that we are able to work across domains and therefore think holistically. Whereas many of our colleagues and counterparts and collaborators are much more embedded in their domain. And for them thinking holistically is maybe less valuable. But it’s again, it’s part of the value we can bring to be able to understand their context, work with them in their context, while also thinking beyond their context.

[00:23:58] Lucie: Yeah, you’ve given me a different perspective of the holistic interventions, and of IDEMS.

[00:24:05] David: And I think, I hope one of the things to take away from this is that I believe holistic interventions is central to the value IDEMS can bring to everyone.

[00:24:13] Lucie: Yeah, exactly.

[00:24:15] David: And yet, it’s something which I think is not necessarily something I’d recommend to many others, which is very interesting. And again, it’s about a good principle has that duality. And I hope we’re getting elements of that duality. We had a principle discussion about being Collaborative by Nature, and the same thing applied there. We are, as an organization, collaborative by nature.

But it’s hard, and I wouldn’t recommend that to other organizations necessarily, because they need to focus on the competition to be able to survive. This is something where it’s something we are able to do, we are doing, but it’s not an obvious, yes, this is how people should work. I believe in it for us, but I recognise the challenges and recognise why this is not to be recommended for many others.

This has been fun.

[00:25:12] Lucie: Yes, great. Thank you so much, David.

[00:25:14] David: Thank you.