Transcript The Obesity Solution: A vision for health AND prosperity in the 21st Century James O.

The Obesity Solution: A vision
for health AND prosperity in the
21st Century
James O. Hill, Ph.D.
Executive Director
John C. Peters, Ph.D.
Chief Strategy Officer
Anschutz Health and Wellness Center
Do We Have a Plan to Reduce
Obesity?
• Currently have lots of tactics
• Tobacco model?
• Policy as driver for change?
The ontogeny of social change for
tobacco, seat belts, recycling
A Crisis
Building Science Base
Strong Advocacy
Formulating a Plan Coalition Building Community Spark Plugs
Local Environment/Policy Change
Economics
Mass Communication
Major Government Intervention
Institutionalizing Effective Action
Nutr. Rev. 59:40, 2001.
What’s Happening?
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NYC - sodas
San Francisco – Happy Meal ban
LA – Zoning fast food restaurants
Tax sodas/fat
Remove vending machines
Almost exclusive focus on food
Food industry does not deserve a seat at the
table – can’t be trusted…Kelly Brownell
What is the future state being
offered?
To lower obesity we will have to
“radically change the way we
live”…..Expert in “Weight of the
Nation”
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Produce and sell less food
Produce and sell fewer
televisions and computers
Produce and sell fewer cars
Produce and sell fewer labor
saving devices
Where’s the Data?
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Sodas and obesity
Marketing and obesity
Fast food and obesity
Vending and obesity
Physical activity/inactivity and obesity
We’ll never get the data – too complex
Problem is too great to wait for the data
Do We Need an Alternative Plan?
Can we offer a different future state?
• Solutions to reduce obesity in the U.S.
must be consistent with American values
• Economic success and competitiveness is
central to these values…land of
opportunity
• Personal liberty – freedom of choice,
fairness
Can health and prosperity
co-exist?
What is the premise?
• Historically, obesity has been seen
as a disease of the wealthy…or, of
prosperity.
• Presently, in the USA we see
disproportionate obesity and
consequences among the
poor…how can this be?
What is prosperity?
• Prosperity is the state of
flourishing, thriving, good fortune
and/or successful social
status…the good fortune and
status definition seems to
dominate our cultural psyche.
• Prosperity often encompasses
wealth but also includes others
factors which are independent of
wealth to varying degrees, such
as happiness and health.
BMI and GDP
It doesn’t take much to be
prosperous in relative terms…
• In the poorest societies around the world
people spend great physical effort simply to
survive…to obtain food, shelter, safety, etc.
• Their environment and circumstances do not
permit the behaviors that lead to obesity.
• Once a minimum level of per capita income
is reached it is possible to obtain relative
excesses of food and inactivity.
• So, in the USA low income groups are
prosperous by one measure…but, other
elements of prosperity may be missing.
Prosperity and obesity
• Despite the apparent paradox in the USA, it is still
true that obesity is a disease of prosperity (at least
financial).
• Most people today are relatively more prosperous
(financially) than their ancestors or people in
developing nations
• In the 21st Century…
– Unintended consequence of a lifestyle that becomes
possible because of individual means or economic
norms for the nation
– In the USA food and inactivity are cheap (both in
monetary and convenience terms)
But, aren’t the rich healthy?
• The rich are not healthy…they just have more money to
pay for things that go wrong
• Poor people today suffer the same maladies but have
less money to pay to fix them
• This speaks to our primary focus on fixing problems
once they occur…vs. preventing them from occurring in
the first place
• Both rich and poor in today’s world do not live a healthy
lifestyle as the norm
• We could spend much of our effort on trying to provide
the same level of “fix it” services to the poor as the
rich…this may be fair, but it won’t fix the underlying
problem?
• The current paradigm is creating generations of unfit and
less productive people…regardless of what social class
they belong to
Happiness and GDP
Money helps, but it’s not everything…
How can we move toward
health and prosperity for
everyone?
Problem Statement
• We know what behaviors are needed to
prevent and treat obesity (and chronic
disease)
• We don’t know how to get individuals or
society to do them in any persistent way
• We have limited knowledge of what and
how to change the environment to make
a persistent difference
• We have only begun to think of this as a
“systems” problem
Motivation…the missing piece
• How do we change our society to live
more healthfully as a matter of course…in
a way that is good for individuals, society,
and the economy…and consistent with
American values?
Many barriers…
• The current rewards system strongly
encourages biologically preferred
behavior…i.e., “bad” behavior
• The rewards for desired behaviors
are mostly time discounted, i.e., not
immediate
• The historical perception of obesity is
that it is a personal issue…it’s a
mindset
What is missing in our
approach today?
We need a better reason for people to be
healthy that matters to them as individuals
and to the nation as a whole…what’s in it for
ME and what’s in it for US?
Let’s change the paradigm
• Current paradigm is that health (and well
being) is essentially a system output…we do
the things in our lives for other reasons and
health is what results from the choices we
make
• A novel approach is to reframe the mindset
such that health is seen as an input to the
system…it is the fuel that allows us,
individually, and collectively to do the things
we want to do…
• It is the fuel for achieving prosperity
Health is currently a system
output…
Inputs
Occupation
Income
Status
Family
Relationships
Nutrition
Physical
activity
Stress
Leisure
Finances
Outputs
Your
Health
What if we considered health as
a system input?
Inputs
Your
Health
Outputs
Occupation
Income
Status
Family
Relationships
Nutrition
Physical
activity
Stress
Leisure
Finances
Well-being as an input?
“For policymakers, the existence of these
mechanisms raises the possibility that a happier
society may be one that intrinsically generates
higher incomes for its citizens. Traditional
thinking has focused upon the opposite.
“Although, in this paper, human well-being is
considered instrumental or as a means—rather
than an end in itself—it needs to be emphasized
that this is not with a view to putting money
center-stage at the expense of happiness. To the
contrary, the results indicate that happiness
and income are connected by a two-way
relationship, and that human well-being can
itself be a source of economic dynamism.”
Forbes, 1/07/2013
We need to think about the
problem in a new way
• Work with the biology…rewards part
of daily life
• Align individual and collective
purpose
• Align purpose and context…work,
school, business
• Not opt in…everyone is part of
it…new behavioral expectations
become “part of the woodwork”
Elements of behavior change
• Changing behavior requires motivation
and support across at least three
domains:
– Personal (Why should I do anything? Personal
What is the purpose that is important to
Structural
ME?)
– Social (Why should WE do anything?
What is the purpose that is important to
US?
– Structural (What rules, policies,
procedures, systems, rewards,
environment will support the purpose?)
Social
What is motivation for the nation?
• What is a more powerful motivator for
society?
– Slowly rising health costs?
– Loss of economic viability and global
competitiveness?
– Declining standards of living?
• We need a systemic motivator that is tied to
American values and is consistent with our
goals as a nation
• And, that has experiential value “in the
present”
Social motivation hierarchy
Transcendence
Well Society
Collective purpose,
American Values,
National Pride
National defense, affordable housing,
safe neighborhoods
Economic health, jobs, global
competitiveness, education
Drive motivation for behavior change by linking
desired behaviors to meeting basic needs
Transcendence
Self-actualization
Esteem
Belongingness and Love
Safety and Security
Physiological
Need to move
the focus
Towards a new paradigm
• If we focused more on well being as
an essential input (fuel) we may tap
the full potential that exists within
people as an essential resource for
our nation
– Health costs would decrease as a side
effect
• What might this look like? How can
health and prosperity coexist in the
21st century?
A sustainable resource
Purpose
Energy
Wellness
A strategy for the 21st century:
Where and how do we start?
Workplaces
Schools & Home
Commerce, the
“Environment”
Health as a valuable, depletable
resource
Inputs
Employees
Health/Wellness
Outputs
Productivity
Innovation
Sustainability
Worksites
Tactics
Incentives
Punishment
Personal responsibility
Conflict
Employee
Want to be healthy
Time challenged
Not enough energy
Need help being healthy
Employer
Want healthy employees
Values productivity
Focus on growth
Benefits from healthy employees
Wellness is fuel for prosperity for both
How can we bring wellness into
the workplace?
• Right now, wellness is thought of as a
“program”…not as part of the business.
• Right now, the reason for doing it is not
aligned with the business purpose (reducing health
care costs is not the core mission of the business).
• Right now, the incentive and rewards
systems are not aligned with wellness goals
(people do what they are rewarded for).
• The way to bring wellness into the work place
is to see it as core to the business.
We need to build a culture of
wellness in to the workplace
• Think of it as an operating system…like
“Windows for Wellness”.
• It is not opt in…it is part of what is expected
of everyone.
• The reason for doing it is that good health is
good for the business…productivity,
recruitment, retention, etc.
• It is no different than why we adopted total
quality, or safety, or diversity, or sustainability.
Isn’t wellness “private”
behavior?
• Not when it affects the business…
• Business already regulates behavior in the
workplace…dress codes, secrecy codes,
harassment codes, safety codes, etc.
• And, if certain behaviors were expected of
everyone it cannot be seen as discriminatory.
• We should evaluate people on their behavior
not just on their biometrics (those are by products of
genes and behavior and will change when behavior changes).
What would a culture of wellness
look like?
• Wellness and employee health are built
into the organizational mission and
values…alignment of purpose
• ALL employees are evaluated in part on how they are
supporting a culture of wellness
• Organizational policies and procedures reflect wellness
goals, when applicable
• Wellness culture is key element of recruitment and
retention
• The value to the business shows up in productivity and
results
A strategy for the 21st century:
Where and how do we start?
Workplaces
Schools & Home
Commerce, the
“Environment”
School of the future
• Better health = better learning
(aligning purpose)
• Promoting good health is expectation
of teachers and administrators, and
they are accountable
• Physical activity used as learning
modality
• School breakfast and lunch aimed at
supporting learning
• Schools must provide permission,
time and resources
• Students, teachers and
administrators are rewarded for
healthy behaviors
A strategy for the 21st century:
Where and how do we start?
Workplaces
Schools & Home
Commerce, the
“Environment”
Creating a Healthy Community
• Worksites and schools catalyze the
demand for healthier options in the
community
• Businesses respond by doing what
they do best…innovating and
delivering
• Health and wellness in the community
increase…driving further engagement
and innovation
• People want to live there, its fun, it’s
energizing…it’s good for the economy
and its good for civic capacity
What would a plan look like?
• What to do
– Align purpose in worksites and
schools
– New labor policies, school policies,
community policies
• Why to do it
– Productivity, learning,
economic viability
• How to implement it
– Start with willing companies,
schools and communities
We can create a new paradigm…
Rituals
and
Routines
Control
Systems
Stories
and Myths
The
“Paradigm”
Organization
Structures
Johnson, 1992
Symbols
Power
Structures
Thank You!