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Henry Ford’s vision for the Model T was that it would 'meet the wants of the multitude' (HO/AFP/Getty Images)
Henry Ford’s vision for the Model T was that it would 'meet the wants of the multitude' (HO/AFP/Getty Images)

Neil Seeman and Kenneth Lam

Extreme affordability: Why we must wear the user's shoes Add to ...

Henry Ford's vision for the Model T was that it would "meet the wants of the multitude." In 1908, that vision changed the automotive industry forever, with ripple effects cascading throughout all of manufacturing. As Steven Watts writes in The People's Tycoon, Ford was not a paragon of virtue - he distributed anti-Semitic screeds, had a decades-long adulterous affair and sustained an emotionally abusive relationship with his son, Edsel. Nonetheless, Ford saw that consumerism "often overlooked questions of social cost."

Ford's Model T was a game-changer. It was a car that wasn't designed for the wealthy minority. The Model T was Pareto-efficient - it didn't make luxury obsolete but it did pave the way to giving the middle classes the option for personal transportation. Ford broke away from the way things had always been done, ingraining the idea of the affordable car as an unshakable feature of American culture.

So what, then, is the difference between affordability and "extreme affordability," an innovation paradigm pivot now being promoted by the Stanford Institute of Design?

The design school observes that vendors have historically been making products that serve "a tiny fraction of the world's population." It's not a bad business calculus when the top 5 per cent hold more than half of the world's wealth, but the school imagines products that cater to the remaining 95 per cent; and so the concept of American affordability needs to get a little more "extreme" if it's going to apply itself to a global market.

Following the school's understanding that "philanthropists are looking for ways to make charity more sustainable," students taking entrepreneurial design for extreme affordability are pushed to be creative with developing world budgets in mind, designing products within a price range affordable for the world's poor. In doing so, they're making "disruptive technologies" in the same way the Model T was disruptive - they create markets that were previously considered impossible. For the masses of people in desperate need of low-cost health-care innovations, this kind of visionary approach can be life-saving.

Take, for example, the JaipurKnee, invented in 2009 at the Stanford Institute. The design is beautifully simple: It's a functioning prosthetic knee that costs less than $20. The JaipurKnee self-lubricates. Its novel hinge device allows for a greater range of motion than previous single-hinge prosthetic knees. Most important, it was designed with price in mind; high-tech prosthetics in North America go for $50,000.

Impressed? Well, for would-be innovators everywhere, the journal for the design school's class on extreme affordability should be mandatory reading. When students visit sites in India, Myanmar, Rwanda, Ethiopia and Nepal, they don't know exactly what they'll be working on. Nor do their teachers - and this is seen as normal. How can Stanford students possibly know what people in these regions want, need and can afford without talking to them? The design school believes in "empathy building" to avoid misguided assumptions.

Taiei Harimoto, a mechanical engineering student who took the eight-month course, spent two weeks in Myanmar investigating Burmese stoves. The professors, he says, "ask us to step inside the shoes of the user and to find new solutions for their latent needs. These are problems that have been there for a while so you ignore that they're there. For us, we're experiencing the difficulties from a fresh perspective and so we think, why not do this a different way?"

Students are also taught to pay attention to the local economy and the user's preferences. Will the product compete with local solutions? Who might lose in the situation? Mr. Harimoto was mindful of whether better stoves in Myanmar would hurt the local sellers of firewood (it won't because 50 per cent gather their own). In his current project with non-profit design firm D-Rev, he applies the common sense rule that, if users don't like a product, it won't be adopted. So D-Rev's product, a blue light used to treat neonatal jaundice, had to look modern, sleek and aspirational because the doctors care about prestige and they associate a modern aesthetic with prestige.

This process has led to two health-related projects: Embrace and Respira. The Embrace team is working on an infant incubator. Wrapped around a premature infant, the incubator is like a sleeping bag that uses a pouch filled with a phase-change material to maintain the baby's body at the proper temperature for as long as four hours. After that, the pouch can be recharged and sanitized in boiling water within a few minutes. It's sufficiently light so it can be easily transported to rural villages. Compared with the $20,000 price of a traditional incubator, the Embrace one costs only $25.

The Respira team is working on an asthma spacer. It has created one out of a single folded sheet of paper. The design has the basic functionality of more expensive spacers for a sliver of the cost in the Western world. "Because paper stacks flat, these spacers can be transported to even the most remote hospitals and clinics, and sent home with any asthma patient," the Stanford Institute's website says.

These are design maxims with broader applicability. Much of the time, technology needs can't be accurately distilled from academic journals or from corporate brainstorming sessions in New York or Toronto, nor can the best "evidence" capture what your most loyal customers actually want. Much of the hand-wringing over how to close North America's "innovation gap" forgets about the needs of the 95 per cent sharing less than half of the world's wealth. But the paradigm shift championed by the Stanford Institute of Design can help innovators everywhere. We just have to step inside the shoes of the user to find a different way.

Neil Seeman is director of the Health Strategy Innovation Cell at Massey College, and co-author of three books on health-care innovation. Kenneth Lam, a recent Stanford chemical engineering graduate, will begin medical school at the University of Western Ontario's Windsor campus.

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