A pyramid of impact

This Health Impact Pyramid provides a conceptual framework for a systems analysis of where to intervene for greatest impact and least individual effort to increase digital inclusion. It is presented here because it gives us a way to sort and understand the solutions proposed by participants in this research.

This pyramid is based on an analysis of studies across countries and time. What it tells us is that intervention at the individual level, for example parent education, tends to be the hardest to enact and and needs to be very comprehensive to have impact (meaning it comes with more cost). On the other hand, interventions to change social conditions - through for example policy, laws and regulation - have the greatest impact on population well being for the least individual effort and generally least cost. Of course, changing social conditions is often not what is easiest politically.

  The Health Impact Pyramid by Thomas R. Frieden.

The Health Impact Pyramid by Thomas R. Frieden.

It is also not necessarily what most people think of immediately when you ask them what could be done to improve their lives. Complex systems are hard to see, even when they are impacting the choices and opportunities available to us. People are naturally inclined to see what is in front of us, and when asked what could be done to change our lives, most of us will think about changing the factors we can see playing a direct and concrete role in our well-being. We tend to suggest changes which seem achievable to us for example our knowledge or behaviour. That is not to say that individual behaviors do not need changing, or skills upgrading. These are real issues for people, but the source of those issues are often to be found outside of the individual.

Another factor influencing the solutions people propose to a wide range of social problems - from poverty to family violence - is a pervasive belief in what is known as the knowledge gap. The knowledge gap is a term used to refer to the idea that social problems persist because people do not have enough information to change behaviours. This belief results in a bias for solutions and interventions that involve educating and informing people, even in contexts where there is strong evidence that a lack of information or skill is not the problem.

One example of this could be that many of the people we heard from in this research suggested that more digital skills could be taught in schools, even when they had not identified a lack of digital skills as a significant barrier to digital access.

However, despite these cognitive biases for individually-focused and knowledge-based interventions, the participants in this research also proposed solutions and interventions at a systemic level - both in terms of changing the digital context to make inclusion the default, and in terms of reducing the social and economic factors that contribute to both social and digital exclusion.

Those proposals have been sorted into three broad levels, based on a simplification of Frieden’s intervention pyramid.

  1. change individual skills and behaviours

  2. change context (to make inclusion the default)

  3. change socio-economic factors.