Public health is in crisis. Design thinking could help

“Together designers and public health professionals can make a great impact on people’s health.”

Public health is in crisis. Design thinking could help
Martelle Esposito working on data synthesis. [Photo: The Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL)]

Martelle Esposito is the founding president and CEO of Mothership, a nonprofit platform for millenial parents seeking health information. She’s also the senior program manager at the Johns Hopkins Bloomberg School of Public Health’s Research Innovation Laboratory for Enhancing WIC Services (HPRIL). She spoke to Doreen Lorenzo for Designing Women, a series of interviews with brilliant women in the design industry.


Doreen Lorenzo: How did you get involved in the public health space?

Martelle Esposito: I studied health and nutrition policy at Tufts University and began my career as a lobbyist in D.C. on Capitol Hill. Over time I started to shift more heavily into the programs and services side of my field, and that’s when I became interested in service design. But policies, programs, and service delivery are all intimately connected. A policy can hinder or enable the design of an effective program or service. So, even though I’ve shifted my focus in recent years, I’m still always thinking about policy implications.

Martelle Esposito [Photo: Mothership]

DL: Tell us a little bit about Mothership. How did you start the organization and what is its mission?

ME: Having spent my career in the maternal and child health space, I developed an understanding of the challenges and opportunities in the field, but it wasn’t until my friends from around the country started having children, and I began to hear their really personal and emotional stories about their struggles with parenthood, that I realized some of these challenges were quite systemic. They were at the core of our health culture in the U.S. and not just issues with a particular health service or program. People were telling me they were feeling ignored or not fully seen by their healthcare providers. They experienced information overload, confusion, and judgment when seeking advice and support. That inspired me to dig deeper around the experience of parents seeking health information and engagement with their health providers. We founded Mothership, a nonprofit with a mission to make better experiences for millennial parents when seeking and obtaining health information and support services.

DL: What role did you feel design could play in your work?

ME: A big role. Much of my work to date has involved the USDA’s WIC program, which is the Special Supplemental Nutrition Program for Women, Infants, and Children. I first started thinking about service design when I was investigating how to improve the WIC service delivery experience. My first foray into design was actually pulling the journey mapping methodology from my spouse, a seasoned product designer, when he was explaining one of his projects to me. I thought to myself, I need to do this for the WIC client experience. I liked how these design methods helped me see and frame challenges and opportunities differently. In public health, we have our own methods for looking at barriers and opportunities, but using design methods like journey mapping took me out of my usual paradigm to be able to think about these things in new ways.


Ever since then I’ve been using design methods to complement my work. We used the Stanford d. School design thinking process in conjunction with a public health framework to develop Mothership’s programs. Most recently, I used journey mapping again to aid program implementation and evaluation planning for my work with Johns Hopkins University, and I also worked with the National WIC Association on a 50-foot interactive journey map at a conference with hundreds of attendees to collect data about the WIC experience.

WIC Journey Map [Photo: The Hopkins/USDA Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL)]

DL: What are some of the projects or initiatives you are most proud of?

ME: One of the projects I’m most proud of is Mothership and the two programs we developed. The first program is called Friends with Health Benefits. It is a health education platform where diverse health professionals who are millennial parents are curating and creating health education content. They are like your wise and edgy older sister giving you advice and encouragement. We are also building digital tools to help parents connect with these relatable health professionals and to content that is tailored to their personal needs and interests. The other program is Mothership Certified, a training and certification for health professionals on building empathy and promoting
empowerment in health practice. During our user research, millennial moms told us they valued information and advice from people that they’ve gotten to know and trust, and who they trusted depended on both their scientific knowledge and having direct parenting experience. There is a level of credibility that comes with having a shared experience. Our key insight about bridging expert and parent friends as a solution came from a discussion that we had with one particular mom. She had a mom friend who was also a nurse that she could turn to for trustworthy advice and nonjudgmental support. I don’t think we would ever have arrived at that conclusion without an intentional design thinking process. This allowed me to see the value of this insight as a potential solution even though it wasn’t thematic in the interviews.

DL: How does quantitative and qualitative research inform what you do?

ME: Quantitative data is important for understanding the scale and the scope of the problem. For example, with Mothership, in addition to qualitative user research, I looked at national survey reports on millennials, parenting, and healthcare as well as scientific journal articles to understand what people had tried before. Quantitative data is also important for assessing program impact. But in terms of designing program details and how to tailor a program to a particular population, which was what I have done WIC and Mothership, qualitative data is key.

Managing the best uses of quantitative and qualitative data is also about leveraging the strengths of public health and design. Both public health professionals and designers have strengths that when put together, that’s where the magic can really happen. In public health, theoretical frameworks offer the design thinking process good constraints for program development. They set the design criteria to create programs that are more likely to have an impact on the target population. Both public health and design have valuable approaches to qualitative data collection, and design methodologies can then help organize data in new ways to inspire innovative ideas and program details. Public health then has the tools to rigorously measure program outcomes. I believe that together designers and public health professionals can make a greater impact on people’s health.


DL: How do you inspire your teams to understand and use design strategy?

ME: Mothership’s team includes designers, so they organically demonstrate the value of design strategy during our program development. To motivate people to try design methodologies in public health, it’s involved a lot of education and showing the value of design with examples. Similar to lobbying, you need to understand your audience and make your issue, idea, or, in this case, methodology relevant to them. In my current role at Johns Hopkins University, I introduced my team to journey mapping and the Stanford d. School Design Thinking Process by sharing how I had used them in the past to complement my work in public health.

DL: Do you think design is here to stay in public health? What trends do you see more people wanting to adapt to?

ME: Definitely. There’s a trend in public health that pairs nicely with human-centered design, and it’s called health equity, which means that everyone has the opportunity to attain their highest level of health. Whereas equality means giving everyone the same thing, equity means you may need to give some populations more help or more resources for them to achieve their optimal health because they’re starting at a disadvantage. We have also seen another complementary trend emerge, in part thanks to the Affordable Care Act, and that is identifying health needs with community needs assessments. A foundational assumption of design is that different users have different needs, so I think design can play a role in understanding and translating community health needs into meaningful programs and policies to achieve health equity.

DL: What are some of the important lessons you’ve learned throughout your career?

ME: Advocate for your ideas. To do that effectively, you first have to understand the system that you want to influence. You have to learn what matters to the various stakeholders and make your idea relevant to them, speaking their language. It’s a lesson I first learned lobbying that has been valuable throughout my whole career.


About the author

Doreen Lorenzo is Assistant Dean at the School of Design and Creative Technologies, and Founding Director of the Center for Integrated Design, both at The University of Texas at Austin.