Editor’s Note: Improving healthcare is a wicked problem [ 1]. Healthcare’s many stakeholders can’t agree on a solution,
because they don’t agree on the problem. They come to the discussion from different points of view, with different frames.
Wicked problems can be “solved” only by reframing, by providing a new way of understanding the problem that stakehold-
ers can share [ 1]. This article describes a growing trend: framing health in terms of well-being and broadening healthcare
to include self-management. Self-management reframes patients as designers, an example of a shift also occurring in
design practice—reframing users as designers. The article concludes with thoughts on what these changes may mean
when designing for health.—Hugh Dubberly
Reframing Health to Embrace
Design of our Own Well-being
hugh dubberly
Dubberly Design Office | [e-mail]
rajiv mehta
Zume Life | [e-mail]
shelley Evenson
Carnegie Mellon University | [e-mail]
Paul Pangaro
CyberneticLifestyles.com | [e-mail]
[ 1] Rittel, H. “On the
Planning Crisis: Systems
Analysis of the ‘First and
Second Generation’.”
Bedrifts Økonomen. 8
(1972): 390-396.

May + June 2010

[ 2] Preamble to
the Constitution of
the World Health
Organization as adopt-
ed by the International
Health Conference,
New York, 19-22 June,
1946. http://www.who.
int/about/definition/en/
print.html/
interactions
[ 3] Workplace stress
and autonomy over
tasks affect health. See:
Ferrie, J., ed., Work,
Stress, and Health:
The Whitehall II Study,
published by Public and
Commercial Services
Union on behalf of
Council of Civil Service
Unions/Cabinet Office,
London, 2004.

What is health?
From the point of view of today’s healthcare
system, health is largely about minimizing ill-
ness. The healthcare system has evolved primar-
ily for treating acute conditions. Despite flaws
(including high cost and limited access), the sys-
tem does a good job of curing infections, repair-
ing injuries, and responding to emergencies.
The healthcare system does less well in treating
chronic conditions. It provides resources for
managing aspects of systemic problems, such as
statins for cholesterol, ARBs and ACE inhibitors
for high blood pressure, and insulins for diabe-
tes; but in most cases that means merely slow-
ing the rate of decline. Yet health is “not merely
the absence of disease or infirmity.” In contrast,
the World Health Organization defines health as
“a state of complete physical, mental and social
well-being” [ 2].
Health as well-being depends not just on
healthcare but also on employer practices [ 3],
social policies [ 4], and self-management, the main
subject of this article. Of course, health is “not
the objective of living”; health is a resource con-
tributing to the quality of our everyday living [ 5].

identifying the Frame of healthcare
The way we usually think about health today
is bound up in the language of our healthcare
system. We call individuals “patients.” We call
physicians healthcare “professionals” (HCPs).
Professionals “care for” patients—by observing
symptoms, diagnosing diseases, and proposing
therapies. Their proposals are not just sugges-
tions; they are prescriptions or literally “physi-
cian orders.” Patients who don’t take their medi-
cine are not “in compliance.”
In the relationship between HCPs and patients,
HCPs dominate. HCPs do whatever is necessary,
with patients playing a relatively passive role [ 6].
In some ways, the system reduces patients to the
status of children—simply receiving treatment.
The power imbalance may grow out of illness.
When we feel ill, we may seek comfort or aid