Assessing social innovations for active and healthy ageing

Social innovations have an important role to play in the process of societies adjusting to ageing populations but it is important to understand both the general and particular social, economic, political and cultural contexts in which they operate.

As Reeder and colleagues noted (Reeder et al., 2012:33):

Community norms, incentives, levels and trust and extent of empowerment have a powerful role in determining the success or failure of a social innovation: what may encourage volunteering in one city may fail in a rural district; what might gain plentiful crowd sourcing in Poland may flounder in Paris.

These contextual variations and the nature of social innovations – new ideas to meet social needs and create new social relationships or collaborations make assessment inherently difficult. Comparisons of effects can be difficult as they rely on counterfactuals to express what would have happened to expenditure and outcomes if the project had not taken place.

Mature, fully sustained initiatives can and should demonstrate a much more robust level of evidence than promising pilots at an early stage of development (Reeder et al., 2012:24-25). However, there are very few high quality outcome evaluations of social innovations, particularly measuring effects on active ageing and healthy life years.

There is a strong case for ‘randomised evaluations’ of social innovations (Schmitz et al., 2013) and the use of randomised control trials for policies (Haynes et al., 2012) but in the absence of this evidence being widely available there is still a pressing need to make judgements on social innovations for active ageing.

A developing process

Assessing social innovations is a developing process and can be viewed as a search for approaches and methods that can produce evidence that is broadly reliable and valid given the inherent complexity and variability of social contexts and interventions.

A particularly useful schema outlined by Brechin and Siddell (2000) highlights three different ways of knowing:

• Empirical knowing: the most explicit form of knowing, which is often based on quantitative or qualitative research study.

• Theoretical knowing: which uses different theoretical frameworks for thinking about a problem, sometimes informed by research, but often derived in intuitive and informal ways.

• Experiential knowing: craft or tacit knowledge built up over a number of years of practice experience (Brechin and Siddell cited in Nutley et al., 2013: 6).

Evidential knowledge on social innovations is likely to be based on experiential knowing from practitioners and people who are engaged with the project. It can also, and arguably should, be based on theoretical knowing. Ideally this should be linked to robust research to provide a plausible theory of change that explains how, why, when and for whom some form of intervention works.

Social innovations will rarely have reached the empirical knowing stage, but that is a worthwhile aspiration that may only be partially achieved even given an abundance of research time and resources. However, this aspiration for ‘good evidence’ inherently involves issues of power, values and a host of other issues that are beyond the scope of this discussion. It is necessary and prudent to be content with evidence that can be considered as ‘good enough’ given what is known about the social world.

Social activity theory

Assessment of social innovations should be based on a judgement of theoretical plausibility. For example, social activity theory contends that older people’s health and well-being is maintained and improved by social participation in leisure and physical activities and role replacement when an established role must be relinquished.

Betts Adams and colleagues (2011) in their review of 42 studies found that despite differences in definition and measurement there were studies that found positive associations between activity and well-being. However, it is difficult to determine the direction of causality between activity and health – are older people more likely to be healthy because of the activities they participate in, or are they more active due to the good health they enjoy?

There are likely to be multiple pathways between activity and health that are difficult to untangle. Therefore, even though we do not completely understand if a social innovation promotes social activity, participation and interaction that reduces social isolation and loneliness, then it is likely to be beneficial to people’s health and well-being (Holt-Lunstad et al., 2010).

While there is certainly a need for a stronger evidence base on social innovations, there is a pressing need to assess their potential impact in relation to active and healthy ageing. The WHO Commission on the Social Determinants of Health (WHO, 2008) faced a similar issue in relation to evaluating evidence and rightly decided that just relying on well controlled experiments would have greatly hindered and limited their work. Therefore, this lack of high quality, controlled experimental evidence “cannot be a barrier to making judgements with the current evidence” (WHO, 2008:42). A similar approach has to be adopted for assessing the potential impact of social innovations based on judgements of theoretically plausible interventions in the social world.

Challenges and opportunities

O’Sullivan and colleagues identified a number of challenges and opportunities for social innovation in later life including

• greater flexibility in pensions

• a greater variety of housing choices such as co-housing and supported living

• novel ways of increasing social interaction so that people do not experience social isolation and loneliness

• policies to encourage people to work longer

• new ways of providing health and social care

• innovative ways of supporting carers

• developing ‘age readiness’ across society

• encouraging volunteering

• developing inter-generational projects that benefit participants and wider society

• age-friendly urban design for all people, and

• inclusive transport solutions (O’Sullivan et al., 2010: 8-10).

Similarly, Khan (2013:11) identified the need to develop innovative solutions to achieve systemic change across five key areas if we were to meet the challenge meeting the needs of a population that has average life expectancy increasing by five hours a day:

1. Social places – mobilising people to help one another so that older people can live well and independently for longer.

2. People-powered health – bringing the social into the medical by combining clinical expertise with self-management and peer support to improve health outcomes.

3. Purposeful work – new employment options that enable people to work purposefully and enjoyably in the second half of life.

4. Plan for life – creating a sense of opportunity as we enter the second half of life.

5. Living room – enabling older people to live where they want through new housing models which combine high quality accommodation with friendships and support.

This range of areas provided a guide for social innovations from around the world that had achieved positive results or showed potential promise in relation to active ageing over the life course. The selected social innovations are diverse but share a dynamism that can have an impact on wider society through bringing about systemic change.

Social innovations develop at different rates over time with some developing rapidly while others take much longer to mature. All of the social innovations for active ageing have gone beyond prompts and proposals to be at least prototypes, while many have been sustained and scaled up whereas some have achieved systemic change. Many projects can progress from prompts through proposals to prototypes relatively quickly but to achieve sustainability, scaling up and systemic change is likely to take time.

Some social innovations have been operating for many years and have achieved significant effects and systemic change while others are only at a pilot project stage but have potential to achieve results in the future. There can be no certainty about the progression of a social innovation as a promising project can be developing but then funding stops and it may cease to operate. The intention is to provide policymakers and social innovators with a wide range of projects that have been tried in one part of the world that could then be used in their locality.

Sources for research

Social innovations were systematically gathered from a wide variety of sources including extensive internet searches, particularly of social innovation hubs and incubators as well as government and voluntary organisation websites. Numerous examples were found from the growing literature on ageing and social innovation, projects identified as showing promise by other organisations and from colleagues working on the MOPACT project.

Scorecard domains

The process of summarising social innovations focused on four scorecard domains – social and economic impact, sustainability, tolerance and implementation – with two elements to each domain.

Social and economic impact

This included an assessment of the probable (theoretically plausible) impact on active and healthy ageing and the system costs. The former refers to the range of factors that influence active ageing while the latter considers the costs of establishing and operating the project.

Sustainability

Sustainability’s two dimensions involved an assessment of the project continuing in its current location. Social innovations often operate on pilot project funding from the public and/or private sector, philanthropic grants, membership/user fees or a market return on their goods or services in order to operate. A fixed term pilot project may be mainstreamed, in whole or partially, if it has been demonstrated to be operating effectively and satisfactorily or it could cease with little potential for continuation.

If a social innovation has a diversity of funding sources and/or a long-term relationship with a funding organisation then there are reasonable grounds to think that it is likely to mature and grow although there is always uncertainty for such socially innovative projects especially if they have fixed costs in the market economy such as wages and rents to pay. Costs and being able to drawn on key personnel, professional expertise or volunteers with a wealth of experience, are likely to be the key elements to the sustainability of a social innovation.

Tolerance

This was assessed in terms of stakeholder support for the social innovation and user friendliness. The score was based on an assessment of how acceptable a social innovation appears, or is likely to be, to organisations and individuals. User friendliness is often critical to social innovations, particularly those that use or rely on new technology, if they are to successfully operate.

A key feature of many social innovations is the involvement of people in the process of co-design from initial prototyping and testing through to co-production of the final product or service. Some social innovations may entrench a digital divide or fundamentally challenge notions of what is socially acceptable and these sorts of factors need to be considered in the scorecard.

Implementation

This considered how easy or difficult it was to implement a social innovation as even when good ideas have been developed through a process of co-design they can still fail at an operational level. This why the earlier stages of social innovation (prompts and prototypes) were excluded: we needed to know that good ideas could be put into practice in the field and this could only be assessed when they have been tested and piloted or are sufficiently mature to have been operating for several years

The second element in the implementation domain is transferability to other locations in the same country or have been successfully transplanted to operate in another country. Some socially innovative projects clearly have great potential for transfer or (re-)development in other countries and just need that creative spark from a social innovator to set the wheels in motion. While evidence of transferability being achieved is desirable as proof that it can be done, there is also scope for taking an optimistic view of the potential of an innovation to make the leap from one country to another. It is highly likely that some social innovations will have made the leap from one country to another but that we are unaware of this transfer.

The scoring system

A simple scale of 1–10 with the following criteria being used to assess the potential social and economic impact:

• 1 or 2 – Very low in terms of practice and potential

• 3 or 4 – Low in terms of practice and potential

• 5 or 6 – Some promise

• 7 or 8 – Clear indications of innovatory effects or promise

• 9 or 10 – Fully achieved

For sustainability (in current location and scalability), tolerance (acceptability and user friendliness) and implementation (ease in site and transferability potential) a similar 1–10 scale was used.

• 1 or 2 – Very weak/poor

• 3 or 4 – Weak/poor

• 5 or 6 – Potential promise

• 7 or 8 – Good/very promising

• 9 or 10 – Very good/highly likely

This scale was applied across the four parts of the balanced scorecard to produce an indicative score out of twenty for the social innovation. This is a rudimentary evaluation of the summarised social innovation and is supplemented with some brief comments on each scorecard element and on the project as a whole.

These are based on a judgement of the available and retrieved evidence on each social innovation, which varies considerably. A social innovation must achieve a score of 24 across the four domains of the balanced scorecard to reach the threshold of actual or potential promise to contribute to active and healthy ageing.

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