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EDITORIAL |
Correspondence: Requests for reprints should be sent to Michael R. Greenberg, PhD, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Ave, Suite 100, New Brunswick, NJ 08901-1958 (e-mail: mrg{at}rci.rutgers.edu).
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INTRODUCTION |
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 TOP INTRODUCTION THREE ELEMENTS OF INNOVATION...INNOVATIONS THAT HAVE AN...References |
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THREE ELEMENTS OF INNOVATION DIFFUSION |
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TOPINTRODUCTIONTHREE ELEMENTS OF INNOVATION...INNOVATIONS THAT HAVE AN...References |
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Attributes of the Innovation
Every new idea has attributes that make it easier or more difficult to diffuse and sustain. People prefer to adopt magic-bullet technical solutions rather than change their behaviors. A pill that promises weight reduction in 3 weeks has much more appeal than a program of gradual change in diet and exercise. But as periodic headline-grabbing tragic deaths of star athletes who were trying to control weight or enhance performance show, we need to know much more about the implications of innovations for the public as a whole, for specific segments of the public, for government, and for business.
I am not suggesting that we become Luddites who oppose and delay every proposed wonder drug, treatment regime, and behavioral modification program. I am suggesting that we need to assess the effect of innovations in the same way we follow the ripples of a stone skimming across a lake. The initial impact of the stone does not necessarily tell us the size and number of peaks and troughs in succeeding ripples. We have learned, sometimes painfully, that innovations set in motion indirect effects upstream and downstream from the innovation that can have a greater effect than the innovation itself.
Environmental Context
Innovations are successful in some places and times and failures in others. We need to know more about the spatial and temporal diffusion of major public health–influencing innovations because that information will tell us how innovators deal with the diversity of norms, values, laws, religions, ideologies, and political issues that can influence the adoption and long-term prognosis of a public health–related innovation.
Characteristics of the Innovators
The marketing ability of innovators, whether they work for government, business, or not-for-profits, seems to be growing exponentially, certainly far more rapidly than our ability to assess and monitor the impacts of innovations. The commercial marketing of alcohol, breakfast cereals, drugs, exercise equipment, food fads, various new forms of gambling, and other innovations is a daunting challenge to all of us. Meanwhile, public health practitioners trying to develop and market ameliorative programs and tools typically face a much more difficult path that requires them to go through legal, political, economic, and other hoops to identify the right ways to shape their innovations to legal, social, and other factors that influence government and not-for-profit based innovations.
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INNOVATIONS THAT HAVE AN IMPACT ON PUBLIC HEALTH |
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TOPINTRODUCTIONTHREE ELEMENTS OF INNOVATION...INNOVATIONS THAT HAVE AN...References |
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Some innovations spread relatively quickly; others are much slower or fail to diffuse. Des Jarlais et al.5 compare the diffusion of the DARE program to reduce the use of illicit drugs with the much slower diffusion of needle exchanges. The authors observe that the DARE program diffused quickly, despite a lack of strong evidence of its salience, whereas needle exchange programs have not, despite strong scientific support for their effectiveness. The article highlights critical social and political environments that frame innovations and affect their diffusion. In a future issue of the Journal, Fajans et al.6 will examine the Strategic Approach to Strengthening Reproductive Health Policies and Programs, a World Health Organization initiative that assesses reproductive health policies and programs. Ongoing nurturing of the Strategic Approach is essential, especially in environments where programs like this one have no history and no organizational framework to anchor them.
Dannenberg et al.7 report the results of a conference aimed at improving and diffusing health impact assessment as a tool for local health planning. The authors recommend evaluation of the method, pilot studies, a database of health impacts, training of practitioners, and other steps that would produce a more effective health impact assessment process. Garland et al.8 assess the role of vitamin D in cancer prevention. They note that evidence points to a positive effect on lowering cancer risk, but they also recognize some of the contrary evidence that doubtless has retarded the acceptance of the vitamin for cancer prevention. Garland and colleagues underscore the uncertainty attached to hundreds of claims about old and new drugs.
During the last 3 decades, concern for environmental protection has produced many technical innovations in monitoring, surveillance, and pollution prevention. Rather than focus on the latest technical improvements, we feature 2 important policy innovations. Greenberg and Hollander9 examine the diffusion of the Environmental Protection Agency’s brownfield pilot program across more than 400 local governments in the United States. They argue that the program has been a successful federalist innovation as measured by its objectives and widespread geographical diffusion. Abrams et al.10 report on the apparent success of New York State’s antismoking campaigns in reducing exposure to environmental tobacco smoke in the workplace.
This issue of the Journal offers specific information about some key innovations related to public health. Equally important, it emphasizes the complexity of the political, economic, and social processes that are often more important than the science and engineering that produced the innovation.
Accepted for publication September 14, 2005.
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References |
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TOPINTRODUCTIONTHREE ELEMENTS OF INNOVATION...INNOVATIONS THAT HAVE AN...References |
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2. Blocker JS Jr. Did prohibition really work? Alcohol prohibition as a public health innovation. Am J Public Health. 2006;96:233–243.
3. Gardner MN, Brandt AM. "The doctors’ choice is America’s choice": the physician in US cigarette advertisements, 1930–1953. Am J Public Health. 2006;96:222–232.
4. Lewis MJ, Wackowski O. Dealing with an innovative industry: a look at flavored cigarettes promoted by mainstream brands. Am J Public Health. 2006;96:244–251.
5. Des Jarlais D, Sloboda Z, Friedman S, Tempalski B, McKnight C, Braine N. Comparing the diffusion of D.A.R.E. and syringe exchange programs. Am J Public Health. In press.
6. Fajans P, Simmons R, Ghiron L. Helping public sector systems innovate: the strategic approach for strengthening reproductive policies and programs. Am J Public Health. In press.
7. Dannenberg AL, Bhatia R, Cole BL, et al. Growing the field of health impact assessment in the United States: an agenda for research and practice. Am J Public Health. 2006;96:262–270.
8. Garland CF, Garland FC, Gorham ED, et al. The role of vitamin D in cancer prevention. Am J Public Health. 2006;96:252–261.
9. Greenberg M, Hollander J. The Environmental Protection Agency’s brown-field pilot program. Am J Public Health. 2006;96:277–281.
10. Abrams SM, Mahoney MC, Hyland A, Cummings M, Davis W, Song L. Early evidence on the effectiveness of clean indoor air legislation in New York State. Am J Public Health. 2006;96: 296–298.
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