10 Wicked Problems in Health: The Big Reveal


Last evening, I attended the Big Reveal where Colorado’s Chief Innovation Officer, Erik Mitisek, introduced 10 wicked problems and the 10 prospective CEOs who are striving to solve them. I have to be honest that the excitement and optimism I felt leading up to the event was replaced with sober acknowledgment; these problems are “wicked” for a reason. Did you know that childhood stress is linked with high incidence of chronic disease like Type 2 Diabetes later in life? And repeated incidents of toxic stress, unabated by a buffering factor such as a consoling parent, can lead to significantly reduced life span. Now, I pride myself as a problem solver, but Toxic Stress is befuddling. How would we organize to intervene during a child’s stressful incident, when the real problem (chronic disease) occurs 20 or 30 years later? The complexity of these problems is daunting. Here’s the full list of wicked problem for 2017:

Toxic Stress - toxic stress in childhood development is the prolonged activation of the stress response systems that can disrupt the development of brain architecture and other organ systems. Examples of stress events include childhood abuse and the death of a family member. Experts say a threshold of 4-6 incidents during childhood significantly increases health issues later in life and can reduce life span 10 to 20 years.

Self-empowerment in Healthcare – to an extent, your health may depend on your ability to be an active partner in your care and wellness. This requires better access to and understanding of your health records, a deeper knowledge of how to lead a healthy and active life, and the motivation to actually initiate healthy behavior.

Health Literacy - Improving the potential for health by increasing patient education and awareness. Similar to "self-empowerment", the underlying hypothesis is that a more informed patient helps improve outcomes. This wicked problem also includes addressing cost issues, billing and insurance transparency, access to high quality data to support clinical and operational decisions, and generally eliminating waste and improving efficiency.

Aligning Incentives to Value – currently, health providers usually get paid for providing a service (such as seeing a patient during a doctor visit), regardless of whether that service corrects the health problem. As an alternative, how can the healthcare system be incentivized to make decisions aligned to positive health outcomes?

Mental Health – mental health disorders are those that affect your mood, thinking or behavior. This is a wicked problem because mental health problems affect everyone, there are many barriers to mental healthcare access, and causes and treatments are not fully understood.

Affordable Housing – skyrocketing rents in some areas are forcing more families to spend upwards of 50% of income on housing. Ordinary and expected healthcare expenses are often deferred or eliminated, negatively impacting health.

Food Insecurity- often driven by socioeconomic conditions, those with poor diets are much more likely to get sick. This problem is complicated by a food industry reacting to profit motives, which often results in marketing of foods that are not healthy. Think of high sugar and high sodium levels baked into foods specifically to make you crave more.

Type 2 Diabetes – Affecting 30 million Americans, with another 60 million with pre-diabetes, diagnoses of this disease increased 382% from 1988 to 2014. Among other real health problems caused by this disease, 200 diabetes patients have a limb amputated every day.

Childcare Accessibility – Normal childhood development requires active and stimulating environments. Childcare is expensive for both families and the government. Standards vary widely from state to state, leading to variations in quality of childcare, which becomes a determinant of health as children grow older.

Implementation Science – a great deal of health -related scientific research is published every year with concrete and evidence based improvements to standard treatment plans. But, a physician would have to read 17 scientific articles, 365 days a year to keep up with research. How can this research find its way quickly to improved treatment?

These wicked problems are not mutually exclusive. There are interdependencies between the problems, for example, toxic stress is an indicator for Type 2 Diabetes later in life. Perhaps the good news is that a solution for one wicked problem may actual help solve a number of problems.

Now that we’re all depressed, it’s time to look on the bright side. We have a group of talented prospective CEOs that started digging into these problems today. The 10.10.10 organization has arranged the best resource possible for the CEOs to ingest and understand the problems and move towards sketching a solution into a business plan. The next few days will be telling. Stay tuned, as I will report on the progress after the 10.10.10 midpoint late this week.

Interested in attending the mid-point event? The event Friday, June 9 at McNichols Civic Center Building in Denver at 4:00 PM. The program is full of interesting speakers and includes a social event afterwords, where you can meet the CEOs, Validators and Ninjas like me. Check out the 10.10.10 program web site here.

Kirstan Vandersluis