John Snow, public health, and innovating in teams

I thought yesterday’s newsletter from author Steven Johnson was spot on. Lightly edited text below..


Last week a combination of work and family vacation brought me back to London for a few days. As often happens when I visit the city, I found myself back in Soho, at the site of the 1854 cholera epidemic that was the subject of my book, The Ghost Map—now almost fifteen years old!

For those of you who don’t know the story, the Soho outbreak famously involved a pump, located at 40 Broad Street, that provided public drinking water for the neighborhood. In late August of 1854, the well water became contaminated with the bacteria that causes cholera, and the community was quickly devastated by the disease. At the time, health authorities believed that diseases like cholera were transmitted through noxious vapors, but a local doctor named John Snow—now considered one of the fathers of epidemiology—had developed a theory that cholera was transmitted via water, and he created a map of the outbreak that showed an unusual concentration of death around the 40 Broad Street pump, ultimately convincing the authorities to remove the pump handle—a true milestone in the history of public health.

For many years, a replica of the pump commemorating the events of 1854 had stood a block or two east of its original location on Broad (now Broadwick) Street. But a few years ago, the pump was relocated to what would have been 40 Broad, next to the corner pub that is now known as The John Snow. I‘ve spent a lot of time walking the streets around Soho, and loitering next to the pump, but this was the first time that I’d visited the area during a family vacation. Somehow seeing the pump in the context of other London tourist landmarks made me see it in a new light.

So many of the grand public memorials in big cities like London are devoted to military events and heroes: think of Lord Nelson towering above Trafalgar Square, or the civil war monument in Grand Army Plaza near our place in Brooklyn. But I was hard pressed to think of another urban monument to a public health breakthrough. (I’m sure some are out there — if you happen to know if one, I’d love to hear about it.) And of course the pump memorial is to scale and almost entirely invisible unless you happened to be standing right next to it; you could walk down Broadwick on the other side of the street and not even notice the thing.

There is something off kilter about the ratios here: both the number and scale of the war memorials, compared to the pump on Broadwick Street. Don’t get me wrong — the lives lost at the Battle Of Trafalgar or during the American Civil War deserve the memorials we have given them. But the pump, in a way, reminds us of a different kind of history: it is a memorial to lives saved, to the hundreds of thousands or millions of people who didn’t die of cholera in part because a local physician in a poor neighborhood saw a pattern in the mortality data and changed our understanding of epidemic disease. The history of the last two centuries is filled with comparable triumphs, breakthroughs that shape our day to day existence in incalculable ways, particularly in large metropolitan areas where epidemic diseases were a daily reality just a few generations ago. Why not celebrate those triumphs as visibly as we celebrate the military victories?

Seeing the pump restored to its original spot reminded me of another idea I’ve been mulling lately. One of the lessons of The Ghost Map is that the classic story of the lone scientific genius is almost always a fiction, condensing down a much more chaotic and collaborative process of discovery into a narrative dominated by a single protagonist. John Snow had always been presented as that kind of heroic scientist in the accounts of the Broad Street outbreak, but it turned out that his idea required the help of a number of other people for it to make a difference in the world: most importantly the local vicar Henry Whitehead, who helped with his investigation, and the statistician and demographer William Farr, who had campaigned for more detailed “open source” mortality reports that supplied Snow with important data. For me, the Ghost Map story was the beginning of an idea that I developed further in Where Good Ideas Come From five years later: that transformative ideas almost always come out of diverse networks, not individuals.

But if you believe in the network model of innovation, that raises a further question: how does a society reward and celebrate those networks, particularly in fields like public health where market-based rewards are more elusive. One primary tool we have are prizes. (If the Nobel prize had been around in the 1850s, it’s entirely possible than Snow would have received one for the waterborne theory of cholera.)

But most prizes — however valuable they are in terms of financial reward and professional status — tend to reinforce the lone genius model, and not just in the case of the “Genius Grants” that MacArthur awards every year. The Nobel Prizes, for instance reward one or two discoverers who hit upon an idea, rather than the loose assemblage of researchers — often in different fields — who contribute pieces of the puzzle that ultimately takes on a coherent shape. The whole architecture of our prize system is designed to celebrate the achievements of the alpha dog who towers above the rest in intellectual achievement. It would be nice to have some prizes that for once tried to celebrate the pack.


Two powerful observations that I hope will be applicable to how we attempt to make progress on climate change.

Surfacing a disagreement vs. finding a quick fix

A common misconception about disagreements is that the biggest value lies in finding a quick fix.

However, disagreements often reveal deeper issues that speak to misaligned values or operating principles. Fixing these issues take multiple conversations, thought, and, in some cases, a willingness to “disagree and commit.” In such cases, rushing to find a quick fix and paper over the cracks can do more harm than good.

So, there’s more long term value in habitually surfacing disagreements over attempting to get to quick fixes.

One way to unlock that value is to celebrate occasions when disagreements are found and/or are clearly articulated instead of just celebrating when they are fixed.

Problems well stated are problems that are easily solved.

On how hard it is to learn something

One of the bigger lessons I’ve taken away from attempting to write about learning and the process of learning over the past 11 years is just how hard it is to learn something.

Learning isn’t about about absorbing a new idea. It is about spending enough time with it to create mental models that change how we see. That, in turn, changes how we do things. To learn and not to do is not to learn after all.

Thus, a small change in how we approach our work and lives can take months and large changes can take years. And, as new years resolutions demonstrate, periodic re-commitment count for a lot more than one-time commitments.

So, for better chances of success at learning – i) pick one thing that you actually want to spend a lot of time on, ii) find a coach, community, or habit that helps you stay accountable to regular experimentation and reflection, and iii) be patient.

The top driver

There are many variables that contribute to our energy on any given day. The quality and type of food we eat, the kind of work/activity we have planned, the quality and quantity of our sleep, and so on.

However, instead of focusing on getting all of them in place, we get disproportionate benefit from focusing on the top driver.

Assuming quantity of sleep is the top driver, there are a lot of associated benefits. On most days, quantity of sleep is likely to translate to quality. And, since we’ll operate with higher energy when we’re awake, it is likely we’ll make better choices through the day.

A focus on the top driver creates forward momentum that makes it easier to focus on the subsequent drivers.

“One metric that matters” is as much about focus as it is about identifying and acting on the top driver. The more we can focus on identifying and acting on the top driver (or in rare cases, two top drivers), the more effective we’ll be.

The Impossible Whopper

I tasted my first Impossible burger last year. I am no burger expert – but, I thought it tasted really good. The Impossible Foods website has some powerful stats on the impact of replacing a beef burger with an Impossible burger.

At a time when the global trends on emissions and climate change aren’t looking good, we need every win we can notch. And, while there’s a lot of power in improving our food choices, the biggest wins come from changes in how massive traditional corporations behave.

Given that, I’m very excited about Burger King embracing “The Impossible Whopper.” Early tests in St. Louis claim to have boosted foot traffic by 18% in comparison to other stores. That’s fantastic news. Even if a portion of that boost is sustained when they launch across the US, it’ll likely inspire the likes of McDonalds to follow as well.

I’m excited to go to a Burger King for a meal myself. I can’t remember the last time I said that.

I have to and I choose to

There’s a great exchange in the chapter on the first habit – “Be Proactive” – of Stephen Covey’s 7 Habits between Covey and a student.


One time a student asked me, “Will you excuse me from class? I have to go on a tennis trip.”

‘You have to go, or you choose to go?” I asked.

“I really have to,” he exclaimed.

“What will happen if you don’t?”

“Why, they’ll kick me off the team.”

“How would you like that consequence?”

“I wouldn’t.”

“In other words, you choose to go because you want the consequence of staying on the team. What will happen if you miss my class?”

“I don’t know.”

‘Think hard. What do you think would be the natural consequence of not coming to class?”

‘You wouldn’t kick me out, would you?”

‘That would be a social consequence. That would be artificial. If you don’t participate on the tennis team, you don’t play. That’s natural. But if you don’t come to class, what would be the natural consequence?”

“I guess I ‘II miss the learning.”

‘That’s right. So you have to weigh that consequence against the other consequence and make a choice. I know if it were me, I’d choose to go on the tennis trip. But never say you have to do anything.”

“I choose to go on the tennis trip,” he meekly replied.

“And miss my class?” I replied in mock disbelief.


I think of this anecdote on days when I hear myself slipping into reactive language. Fortunately for many of us, we choose to more than we have to.

It is on us to make the most of it.

The ball in front of you

You can only play the ball in front of you.

It is good to prepare for that shot you really want to hit and it is also good to reflect on the shots you missed – both in moderation.

However, what matters most right now is playing the ball in front of you.

How you hit that is both the culmination of what you’ve learnt from the past as well as the path to what you want to do in the future.

Focus on playing it well.