By Robert L. Moore, MD, MPH, MPA, Chief Medical Officer
“The tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.”
– Author Malcom Gladwell
Malcolm Gladwell’s first book, The Tipping Point: How Little Things Can Make a Big Difference, published in 2000, was one of the earliest popular books in the field now called behavioral economics. Classics that followed include Freakonomics, written by Steven Levitt and Stephen Dubner in 2005, Predictably Irrational, by Dan Ariely in 2008, Nudge by Nobel Laureate Richard Thaler and Cass Sunstein, and Thinking Fast and Slow, written by Nobel Laureate Daniel Kahneman in 2011. Collectively, these books combine elegant psychological experiments and data analysis using novel economic methods to dispel age-old assumptions about motivation and human behavior.
In his just-released eighth book, Revenge of the Tipping Point, Malcolm Gladwell examines the factors leading individuals to dramatically change their beliefs and values in response to the people around them. The many healthcare examples alone make it a worthwhile read for Medical Directors.
A particularly thought-provoking chapter is Chapter 4, The Magic Third. He presents a series of studies that show that 25-33% of a group of people can sway the rest of the group to the same set of beliefs/behaviors/values – the “Magic Third.” Examples include studies of the number of women on corporate boards, the number of Black children in mixed-race kindergarten classes, the percentage of Black residents in a neighborhood, and an elegant psychological experiment involving groups of people agreeing on names of random people in images. The “tipping point” in which major changes in the group cascaded rapidly was between 25 and 33 percent of the group. Gladwell goes as far as calling the Magic Third a “Universal Law,” a term social scientists and philosophers use in a way that is disconcerting to physicists.
One interesting experimental finding is that if 25-30% of a group are coordinated in trying to sway an entire group to their view (say on length of two lines, or the number of objects in a picture), they will generally be successful, even if the view they are agreeing on is demonstrably untrue! Social pressure is powerful!
On the other hand, the current political environment in Washington D.C. demonstrates that deeply held beliefs are not as susceptible to the “Universal Law” of the Magic Third.
I have observed cases where less than one third of a group can sway the entire group. In the 1980s, vintners in different areas of California formed local trade groups to promote wines from their region. They sometimes held charity fundraisers, combining marketing of their products with philanthropy. In one case, the Napa Valley Vintners, the target of fundraising shifted substantially from supporting local hospitals to focus on supporting the farmworkers and their families who worked in the region. This change occurred when just two board members (former publisher John Shafer, owner of Shafer Vineyards, and Bill and Kathy Collins of Conn Creek Winery) worked together to sway the views of their fellow vintners. For approximately 30 years (even after the deaths of Shafer and the Collins’s), vintners throughout the valley would all say that the focus of their wine auction and other philanthropic activities was to care for the farmworkers who worked in the fields, making their wine possible. Vintner groups in surrounding counties did not develop the same shared goal.
A key lesson from the Napa Valley Vintners is that two charismatic leaders, working together, can shift the views of an entire group, even if they initially comprised less than 25% of the group. However, it takes a bit of effort and time to get to the tipping point and beyond.
A look at major public health initiatives in California and other major health policies find this pattern repeating: two passionate dedicated individuals focus their energy to changing the framing or narrative, gradually swaying the larger group (or even the whole population) to their frame/narrative.
If one person has an innovative policy idea, their first important task is to find a second charismatic person who will support the idea. Together, with time and attention, these two can often sway the rest of the group.
Patience and focus are key. Having too many priorities means that insufficient attention goes to any one of them, and success will be limited. Partnership HealthPlan of California tracks the public health priorities of all 24 of our counties. In some counties, there are so many priorities that the health officer cannot remember them all without looking them up. Lake County has adopted a different model inspired by a framework called Collective Impact. The health department is mobilizing all major county stakeholders to focus intensively on one high priority issue: nicotine consumption in youth. I have no doubt that this approach will have a substantial impact.
So, don’t make too many New Year’s Resolutions. Choose no more than one difficult-to-achieve goal and stick with it. If your goal requires changing the behavior or views of people around you, first find a partner to work with you.
As we look ahead to 2025, which may bring many changes, finding ways to make meaningful differences in our communities can provide resilience. We at Partnership look forward to working with you to make our local healthcare system as functional as we can, providing care and comfort to the communities we serve.