Category Archives: nutrition

healthy habits, nutrition, policy, politics

Fixing obesity :: Hard, yes. Complicated, no.

We are drowning in copious quantities of poor-quality (even willfully addictive) calories, and labor-saving technologies all too often invented in the absence of need. We have run out of time to see that this is like the other kind of drowning, a clear-cut case of calamitous cause-and-effect, albeit in slower motion, playing out over an extended timeline.

We could fix obesity. It’s hard, because profit and cultural inertia oppose change. But it’s not complicated. (And maybe it isn’t even as hard as we tend to think.)

As we look out at an expanse of bodies sinking beneath the waves of aggressively-marketed junk and pervasive inactivity, wring our hands and contemplate forming more committees — I can’t help but think we’ve gone right off the deep end.

 

http://www.huffingtonpost.com/david-katz-md/obesity-epidemic_b_3292179.html

David Katz, M.D.

Director, Yale Prevention Research Center

Fixing Obesity
Posted: 05/17/2013 12:05 pm
 

Earlier this week I spoke at a symposium on nutrition and public health at the Tuck School of Business at my alma mater in beautiful Hanover, N.H., Dartmouth College. Among others on the panel with me was Richard Starmann, the former head of Corporate Communications for McDonald’s. Those with even a modest number of Katz-column frequent flyer miles can readily guess how often he and I agreed.

One point Mr. Starmann made, more than once, was that rampant obesity and related chronic disease was enormously, intractably complicated and would require diverse efforts, a great deal of private sector innovation, minimal government intercession, lots of time, lots of money, and many conferences, committees and panels such as the one we were on to fix. I had trouble deciding where to start disagreeing with this one.

For one thing, if you have ever served on a committee, you likely know as well as I that the surest way to never fix something is to convene a whole lot of committees and panels to explore every possible way of disagreeing. Just look at our Congress.

But more importantly: Obesity is not complicated. And neither is fixing it. Hard, yes; complicated, no!

Before I make that case — emphatically — a brief pause to note the essentials of informed compassion. Yes, it is absolutely true that some people eat well and exercise, and are heavy anyway. Yes, it is absolutely true that two people can eat and exercise the same, and one gets fat and the other stays thin due to variations in genetics and metabolism. Yes, it is absolutely true that some people gain weight very easily, and find it shockingly hard to lose. Yes, it is absolutely true that the quality of calories matters, along with the quantity. Yes, it is absolutely true that factors other than calories in/calories out may influence weight and certainly health, including such candidates as the microflora of our intestinal tracts, exposure to hormones, GMOs, and more.

But on the other hand, once we contend effectively with the fact that we eat way too many calories, that “junk” is perceived as a legitimate food group, and that we spend egregiously too much time on our backsides rather than our feet — we might reasonably address only the remaining fraction of the obesity epidemic with other considerations. I am quite confident that residual fraction would be very small.

Which leads back to: We can fix obesity, and it isn’t complicated.

As a culture, we are drowning in calories of mostly very dubious quality, and drowning in an excess of labor-saving technology. I have compared obesity to drowning before, but want to dive more deeply today into the implications for fixing what ails us.

Let’s imagine, first, if we treated drowning the way we treat obesity. Imagine if we had company executives on panels telling us why we can’t really do anything about it today, because it is so enormously complicated. Imagine if we felt we needed panels and committees to do anything about epidemic drowning. Such arguments could be made, of course.

For, you see, drowning is complicated. There is individual variability — some people can hold their breath longer than others. Not all water is the same — there are variations in density, salinity, and temperature. There are factors other than the water — such as why you fell in in the first place, use or neglect of personal flotation devices, and social context. There are factors in the water other than water, from rocks, to nets, to sharks.

The argument could be made that anything like a lifeguard is an abuse of authority and an imposition on personal autonomy, because the prevention of drowning should derive from personal and parental responsibility.

The argument could be made that fences around pools hint at the heavy hand of tyranny, barring our free ambulation and trampling our civil liberties.

We would, if drowning were treated like obesity, call for more personal responsibility, but make no societal effort to impart the power required to take responsibility. In other words, we wouldn’t actually teach anyone how to swim (just as we make almost no systematic effort to teach people to “swim” in a sea of calories and technology).

Were we to treat drowning more like obesity, we would have whole industries devoted to talking people into the choices most likely to harm them — and profiting from those choices. One imagines a sign, courtesy of some highly-paid Madison Avenue consultants: “Awesome rip current: Swim here, and we’ll throw in a free beach towel! (If you ever make it out of the water…)”

If we treated swimming and eating more alike, we would very willfully goad even the youngest children into acts of peril. An announcer near that unfenced pool would call out: “Jump right in, there’s a toy at the bottom of the deep end! And don’t worry, the pool water is fortified with chlorine — part of a healthy lifestyle!”

I could go on, but you get the idea. But you also, I trust, have reservations. As you recognize that treating drowning like obesity would be ludicrous, you must be reflecting on why drowning isn’t like obesity. I’ve done plenty of just such reflecting myself, and here’s my conclusion: time.

The distinction between drowning in water, and how we contend with it, and drowning in calories and sedentariness, is the cause-and-effect timeline. In the case of water, drowning happens more or less immediately, and there is no opportunity to dispute the trajectory from cause to effect. In the case of obesity, there is no immediacy; the drowning takes place over months to years to decades. It’s a bit blurry.

Really, that’s it. If you disagree, tell me the flaw — I promise to listen.

We have the time perception of our ancestors, contending with the immediate threats of predation and violence on the savannas of our origins. We are poorly equipped to perceive calamitous cause-and-effect when it plays out in slow motion. One imagines viewing ourselves through the medium of time-lapse photography, and suddenly seeing the obvious: We topple into the briny, obesigenic depths of modern culture, and emerge obese. Cause and effect on vivid display, no committees required.

Consider how differently we would feel about junk food if it caused obesity or diabetes immediately, rather than slowly. Imagine if you drank a soda, and your waist circumference instantly increased by two inches. It likely will — it’s just a matter of time.

We generally deal effectively with cause-and-effect catastrophes that have the “advantage” of immediacy. One obvious exception comes to mind: gun violence. If the “pool lobby” were to address drowning the way the gun lobby addresses gun violence, the solution would somehow be more pools, fewer fences, and no lifeguards. But that will have to be a rant for another day, so let’s not go down that rabbit hole.

Instead, let’s flip the comparison for a moment. What if saw beyond our Paleolithic perceptions of temporality, recognized the cause-and-effect of epidemic obesity and chronic disease, and treated the scenario just like drowning?

We would, indeed, rely on parental vigilance and responsibility — but not invoke them as an excuse to neglect the counterparts of fences and lifeguards. We would impede, not encourage, children’s access to potentially harmful foods. We would avoid promoting the most dangerous exposures to the most vulnerable people.

We would recognize that just as swimming must be taught, so must swimming rather than drowning in the modern food supply and sea of technology. We would teach these skills systematically and at every opportunity, and do all we could to safeguard those who lack such skills until they acquire them. Swimming is not a matter of willpower; it’s a matter of skill-power. So, too, is eating well and being active in a world that all too routinely washes away opportunities for both.

Your “eye for resemblances” is likely as good as mine, so I leave a full inventory of all the anti-obesity analogues to defenses against drowning to your imagination. They are, of course, there for us: analogues to lifeguards, fences, swimming lessons, warnings against riptides, beach closures, personal responsibility and vigilance, public policies, regulations and restrictions, and a general pattern of conscientious concern by the body politic for the fate of individual bodies.

The only real distinction between drowning in water and drowning in calories related to causality is time. One hurts us immediately, the other hurts us slowly. The other important distinction is magnitude. People do, of course, drown, and it’s tragic when it happens. But obesity and chronic disease affect orders of magnitude more of us, and our children, and rob from us orders of magnitude more years of life, and life in years.

No one with a modicum of sense or a vestige of decency would stand near a pool, watch children topple in one after another, and wring their hands over the dreadfully complicated problem and the need for innumerable committees to contend with it.

We are drowning in copious quantities of poor-quality (even willfully addictive) calories, and labor-saving technologies all too often invented in the absence of need. We have run out of time to see that this is like the other kind of drowning, a clear-cut case of calamitous cause-and-effect, albeit in slower motion, playing out over an extended timeline.

We could fix obesity. It’s hard, because profit and cultural inertia oppose change. But it’s not complicated. (And maybe it isn’t even as hard as we tend to think.)

As we look out at an expanse of bodies sinking beneath the waves of aggressively-marketed junk and pervasive inactivity, wring our hands and contemplate forming more committees — I can’t help but think we’ve gone right off the deep end.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

complex adaptive systems, data saving lives, healthcare, healthy habits, management and leadership, nutrition, policy, rapid learning health systems

Health Care Value

There’s a lot of good buried in this post, but it’s all starting to sounds like the development of a perfect map… not that inspiring.

The data is already there. At a national level, it can be used to inform a national increase in health funding… functioning like a CPI.

——-

Michael Porter defines value as “health outcomes achieved per dollar spent.” … An efficient business gets the most output possible, given current technology, from every dollar spent.

Porter and colleagues adapt microeconomics to health care through their definition of output: patient-centered health outcomes. These are results that individual patients desire: survival, speedy and uncomplicated recovery, and maintenance of well-being over the long term. These are also things that clinicians, payers, and purchasers should seek for their patients, employees, and customers.

The value movement’s definition of outcomes treats the patient as a whole person, insists that measures of outcome transcend disease-specific indicators to account for all of the patient’s conditions, and include data collected over time and space to produce comprehensive measures of patient well-being. Value proponents further insist that inputs be measured comprehensively to include all the costs of producing desired outcomes.

Widely adopted, the concept of value would provide a north star toward which health care providers could navigate.  Its emphasis on the whole patient and comprehensively measured costs would encourage teamwork among clinicians and coordination of care across specialties, clinical units, and health care organizations. The focus on patient-centered outcomes would support increased effort to measure patient-reported outcomes of care, such as their level of function and perceived health status over time.

[…] the lack of data systems to support outcome measurement.  Producing the holistic assessments needed requires the aggregation over time and space of data from multiple clinicians and health care organizations, as well as patients themselves. The health care system’s electronic data systems are just now entering the modern age.

To turn the promise of value measurement into the reality of better care at lower cost, a few short-term actions seem prudent. First, the nation needs a plan to turn the concept of value into practical indicators. Since government, the private sector, consumers and voters all have a vital stake in health system improvement, they should all participate in a process of perfecting and implementing value measures, preferably under the leadership of a respected, disinterested institution. The Institute of Medicine comes to mind, but others could be imagined.  This process should produce an evolving set of measures that will be imperfect initially but improve over time.

Second, both government and the private sector need to invest in the science and electronic data systems that support value measurement. Investments in systems should focus on speeding the refinement of standards for defining and transporting critical data elements that must be shared by patients, providers, and insurers to create patient-centered outcome measures.

 

 

http://blogs.hbr.org/2013/09/getting-real-about-health-care-value/

via

http://www.commonwealthfund.org/Blog/2013/Sep/Should-Value-Be-the-New-Mantra-in-Health-Care.aspx?omnicid=20

Getting Real About Health Care Value

by David Blumenthal and Kristof Stremikis  |   12:15 PM September 17, 2013

Words can spearhead social transformation.  Let’s hope that’s true for “value” in health care. Where other mantras – such as quality or managed care – have failed to galvanize the system’s diverse stakeholders, value may have a chance.

What seems special about the term is that, seemingly simple, it is actually complex and subtle. Under its umbrella, a wide range of interested parties can find the things they hold most dear, from improved patient outcomes to coordination of care to efficiency to patient-centeredness. And it is intuitively appealing. As Thomas Lee noted in the New England Journal of Medicine, “no one can oppose this goal and expect long-term success.”

The question, of course, is whether the term will help spur the fundamental changes that our health care sector so desperately needs. In this regard, a closer examination of the value concept confirms its appeal but also exposes the daunting challenges facing health system reformers.

Michael Porter has defined value as “health outcomes achieved per dollar spent.” Any survivor of introductory microeconomics will hear echoes in this phrase of one basic measure of economic efficiency: output per unit of input. An efficient business gets the most output possible, given current technology, from every dollar spent.

Porter and colleagues adapt microeconomics to health care through their definition of output: patient-centered health outcomes. These are results that individual patients desire: survival, speedy and uncomplicated recovery, and maintenance of well-being over the long term. These are also things that clinicians, payers, and purchasers should seek for their patients, employees, and customers. The value movement’s definition of outcomes treats the patient as a whole person, insists that measures of outcome transcend disease-specific indicators to account for all of the patient’s conditions, and include data collected over time and space to produce comprehensive measures of patient well-being. Value proponents further insist that inputs be measured comprehensively to include all the costs of producing desired outcomes.

Widely adopted, the concept of value would provide a north star toward which health care providers could navigate.  Its emphasis on the whole patient and comprehensively measured costs would encourage teamwork among clinicians and coordination of care across specialties, clinical units, and health care organizations. The focus on patient-centered outcomes would support increased effort to measure patient-reported outcomes of care, such as their level of function and perceived health status over time.

Promising as it is, the emphasis on value also raises illuminating and challenging questions. The first is: why all the fuss with defining it? In most markets consumers define value by purchasing and using things. In the 1990s, personal computers had considerable value. We know that because consumers bought lots of them. Now, with the arrival of tablets, personal computers seem to be losing value.  And so it goes for untold numbers of goods and services in our market-oriented economy. Eminent professors don’t wrack their brains defining the intrinsic value of electric shavers, overcoats, or roast beef.

We need to define the value of health care, however, for a simple but profound reason explained in 1963 by Nobel-prize-winning economist Kenneth Arrow. Arrow showed that health care markets don’t work as others do, because consumers lack the information to make good purchasing decisions. Health care is simply too complex for most people to understand. And health care decisions can be enormously consequential, with irreversible effects that make them qualitatively different from bad purchases in other markets. Americans are therefore reluctant to let the principle of caveat emptor prevail. One reason to define value carefully and systematically is to enable consumers to understand what they are getting, an essential condition for functioning health care markets.

The compelling need for a good definition of health care value highlights another fundamental challenge. We have not yet developed scientifically sound or accepted approaches to defining or measuring either patient-centered outcomes of care, or – surprisingly – the costs of producing those outcomes. The scientific hurdles to defining patient-centered outcomes are numerous. Outcomes can be subtle and multidimensional, involving not only physiological and functional results, but also patients’ perceptions and valuations of their care and health status.  The ability of health care organizations to measure costs is primitive at best and doesn’t meet the standards used in many other advanced industries. Equally challenging is the lack of data systems to support outcome measurement.  Producing the holistic assessments needed requires the aggregation over time and space of data from multiple clinicians and health care organizations, as well as patients themselves. The health care system’s electronic data systems are just now entering the modern age.

Given the value of measuring value, and the current obstacles to doing so, still another urgent question arises: what should we do now? Despite recent moderation in health care costs, our health care system is burning through the nation’s cash at an extraordinary rate and producing results that, by almost every currently available measure, are disappointing.

To turn the promise of value measurement into the reality of better care at lower cost, a few short-term actions seem prudent. First, the nation needs a plan to turn the concept of value into practical indicators. Since government, the private sector, consumers and voters all have a vital stake in health system improvement, they should all participate in a process of perfecting and implementing value measures, preferably under the leadership of a respected, disinterested institution. The Institute of Medicine comes to mind, but others could be imagined.  This process should produce an evolving set of measures that will be imperfect initially but improve over time.

Second, both government and the private sector need to invest in the science and electronic data systems that support value measurement. Investments in systems should focus on speeding the refinement of standards for defining and transporting critical data elements that must be shared by patients, providers, and insurers to create patient-centered outcome measures.

Third, in consultation with consumers and providers, governments need to develop privacy and security policies that will assure consumers that their health care data will be protected when shared for the purpose of value measurement.

Last, and perhaps most important, the trend toward paying providers on the basis of the best available value measurements needs to continue. These payment policies motivate providers to use value measures to their fullest extent for the purpose of improving processes of care and meeting patients’ needs and expectation.

To some observers putting value at the forefront of health care reform may seem obvious and non-controversial.  As Lee notes, who can be against it?  To use an American cliché, it seems a little like motherhood and apple pie: comfortable and widely endorsed. But the value movement could be much more than that.  When value does become a well-accepted principle, we’ll be much closer to making health care better for everyone.

Follow the Leading Health Care Innovation insight center on Twitter @HBRhealth. E-mail us athealtheditors@hbr.org, and sign up to receive updates here.

complex adaptive systems, healthcare, healthy habits, musings, nutrition, policy, politics, rapid learning health systems, storytelling

Katz smashes it again… it’s the culture, stupid.

“Bariatric surgery is effective and should be available to those who need it. I have referred patients for such surgery over the years. But our culture will be defined by what we learn and share. We could learn and share the skill set for losing weight and finding health, and make that our cultural norm.”

…but how do we operationalise culture change…. it is massive task, but it needs to happen. Purpose perhaps?

http://www.linkedin.com/today/post/article/20140121144506-23027997-obesity-and-oblivion-or-what-i-ve-learned-under-general-anesthesia

Director, Yale University Prevention Research Center

Obesity and Oblivion- or- What I’ve Learned Under General Anesthesia

David L. Katz, MD, MPH

January 21, 2014  

I am going to tell you what I’ve learned under general anesthesia, but I ask you to bear with me kindly and wait a few paragraphs for that revelation.

I am a rambunctious guy, pretty much always have been. I have always loved active recreation and was one of those kids who had to be reeled in for dinner from outside play with a winch and a cable. As an adult, I placate the restlessness of my native animal vitality with about 90 minutes of exercise every day. In addition, I hike whenever I can, and pretty much share my dogs’ attitude about it: the more miles, the better. I studied the martial arts for years. I am a lifelong, avid alpine skier, and an ardent equestrian– privileged to share that latter brand of rambunctiousness with my beautiful horse, Troubadour, who seems to enjoy running and jumping as much as I do, and is far better at it.

This is all part of family tradition. Women in the family are generally quite active, and some have their share of perennial restlessness. But the guys are a case apart. My son’s rambunctiousness is, quite literally, famous of song, story, and program. The ABC for Fitness™ program Gabriel directly inspired is now reaching hundreds of thousands of kids around the country and world, and paying forward the benefits of daily exercise in schools. Gabe helped me appreciate the importance of asserting that the proper remedy for rambunctiousness in our kids is recess, not Ritalin.

And then there’s my father, whose restlessness is the granddaddy of all, and the stuff of legend, or at least family lore. We celebrated his 74 birthday last summer with a hilly, 56-mile bike ride.

By and large, the effects of this rambunctiousness are extremely positive. My animal vitality is spared the constraints of leash or cage, and rewards me reciprocally with energy, stamina, and productivity. But everything has a price. My particular brand of rambunctiousness has involved pushing limits, and limits have a tendency of pushing back. The result is several concussions (I am now a consistent helmet wearer), too many stitches to count, roughly 20 broken bones, and general anesthesia to restore the mangled anatomy of some joint or other not fewer than a half dozen times.

Which leads, at last, to what I’ve learned under general anesthesia: Nothing. Nada. Zip.

Nobody learns anything under general anesthesia. General anesthesia involves unconsciousness; oblivion.

And on that basis, I consider it a societal travesty that hyperendemic obesity and the metabolic mayhem that often follows in its wake are treated ever more frequently, in ever younger people, under general anesthesia. Our answer to obesity is, it seems, oblivion.

True, bariatric surgery is effective. But it is also expensive, and subject to all of the potential complications of surgery. We don’t really know how long the benefits last, particularly for the children and adolescents who are candidates in growing multitudes. We do know that lasting benefit requires ancillary lifestyle change, and that there is often some, and sometimes a lot, of weight regain despite the rewiring of the gastrointestinal tract.

And we know as well that we are relying on scalpels in the hands of others to do what forks in our own hands (and feet in our own shoes) could do better, at dramatically lower cost and risk, if our society committed to empowering their more salutary use. We have evidence to suggest that schools and aptitudes acquired there could do for weight what scalpels applied under anesthesia do. But in my experience, they could do so much more. As a medical advisor at Mindstream Academy, a boarding school producing weight loss to rival bariatric surgery, I have been far more impressed with what the kids find than what they lose, impressive though the latter may be. They find pride and proficiency; confidence and competence; skillpower and self-esteem. They learn, in other words- as nobody ever does under general anesthesia.

Our society’s tendency to “over-medicalize” has been chronicled by others. The consequences extend to expecting from our clinics what only our culture can deliver. Among the most vivid illustrations of this is the lifelong work of my friend, Dean Ornish. Dr. Ornish was involved in groundbreaking work that showed the capacity for a lifestyle overhaul to rival the effects of coronary bypass surgery. With evidence in hand that feet and forks (and a short list of other priorities attended to) could do for coronaries what scalpels could do, Dr. Ornish set out to make his lifestyle program a reimbursable alternative to surgery. He succeeded, earning Medicare reimbursement after – wait for it- 17 years! I don’t know that Dean has the patience of a saint, but he apparently does have the patience of a cicada.

It took 17 years to gain reimbursement for lifestyle as a cost-effective treatment of coronary artery disease, whereas surgery was reimbursed from the get-go. That’s how we roll, and then wring our hands about the high costs of health care.

With that in mind, I ask my fellow parents reading this column; I ask the grandparents, godparents, aunts and uncles to contemplate this: How many of our sons and daughters, nieces, nephews, and grandchildren will have passed through the O.R. doors if it takes us two decades to establish lifestyle intervention as a culturally sanctioned alternative to bariatric surgery? However many that is, I can tell you exactly what they will all learn while under general anesthesia: Nothing. Nada. Zip.

Knowledge and experience are the foundational elements of culture itself. Culture derives from the capacity of our species to learn, and pay forward our learnings to our contemporaries and our children. Among the impressive manifestations of effective school-based approaches to adolescent obesity is the capacity, and proclivity of the kids to pay their newly acquired skillpower forward. When last I visited Mindstream Academy, one of the young girls there, who had lost some 80 lbs, was most proud to tell me about her father back at home who, courtesy of her long-distance coaching, had lost about 40. There is nothing to pay forward following the oblivion of general anesthesia.

Bariatric surgery is effective and should be available to those who need it. I have referred patients for such surgery over the years. But our culture will be defined by what we learn and share. We could learn and share the skill set for losing weight and finding health, and make that our cultural norm. That remains unlikely so long as we put our money preferentially where our medicalizations are. The AMA has proclaimed obesity a disease, but that’s just symptomatic of our culture tendencies. It is more a disease of the body politic than of the often healthy bodies that succumb to it in a culture that propagates its causes.

The healthiest, happiest, leanest, longest-lived populations on the planet do not attribute such blessings to the proficiency of their surgeons or the frequency of their clinical encounters. They attribute them to the priorities and prevailing norms of their culture.

Nobody learns anything under general anesthesia. General anesthesia is oblivion. If we keep prioritizing the medical over the cultural, oblivion over enlightenment, my friend Dean Ornish will remain a lonely pioneer. And the cicadas, when next they emerge, will see nothing new. They will have cause to roll their protuberant eyes at us and trill out: same as it ever was.

It doesn’t have to be that way. We could choose oblivion a bit less often, and stay conscious instead. Conscious, we would have a chance to think outside the box of surgical gloves- and perhaps thereby perceive a new world of opportunity.

-fin

Dr. Katz was recently named one of the most influential people in Health and Fitness (#13) byGreatist.com. His new book, DISEASE PROOF, is available in bookstores nationwide and at:

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

http://www.facebook.com/pages/Dr-David-L-Katz/114690721876253
http://twitter.com/DrDavidKatz
http://www.linkedin.com/pub/david-l-katz-md-mph/7/866/479/

data saving lives, facts & data points, healthcare, nutrition, policy, quantified self, rapid learning health systems, research methodology

Institute for Health Metrics and Evaluation (IHME)

Gates Foundation backed Washington University team doing some amazing work on gathering, analysing and presenting global burden of disease metrics for easy browsing.

http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow-diagram

Data Visualizations

IHME strives to make its data freely and easily accessible and to provide innovative ways to visualize complex topics. Our data visualizations allow you to see patterns and follow trends that are not readily apparent in the numbers themselves. Here you can watch how trends in mortality change over time, choose countries to compare progress in a variety of health areas, or see how countries compare against each other on a global map.

Not sure which visualization will provide you with the results you are looking for? Click here for a guide that will help you determine which tool will best address your data needs.

GBD Compare is new to IHME’s lineup of visualizations and has countless options for exploring health data. To help you navigate this new tool, we have a video tutorial that will orient you to its controls and show you how to interact with the data. You can also watch the video of IHME Director Christopher Murray presenting the tools for the first time at the public launch on March 5, 2013.

Tobacco Burden Visualization

This interactive data visualization tool shows modeled trends in tobacco use and estimated cigarette consumption worldwide and by country for the years 1980 to 2012. Data were derived from nationally representative sources that measured tobacco use and reports on manufactured and nonmanufactured tobacco.

US Health Map

With this interactive map, you can explore health trends in the United States at the county level for both sexes in: life expectancy between 1985 and 2010, hypertension in 2001 and 2009, obesity from 2001 to 2011, and physical activity from 2001 to 2011.

GBD Compare

Analyze the world’s health levels and trends in one interactive tool. Use treemaps, maps, and other charts to compare causes within a country, compare countries with regions or the world, and explore patterns and trends by country, age, and gender. Drill from a global view into specific details. Watch how disease patterns have changed over time. See which causes of death and disability are having more impact and which are waning.

Mortality Visualization

How does input data become a GBD estimate? Walk through the estimation process for mortality trends for children and adults for 187 countries. See the source data and then watch as various stages in the estimation process reveal the final mortality estimates from 1970 to 1990.

COD Visualization

Where do we have the best data on the different health conditions? For any age group, see where the various data sources have placed the trends in causes of death over time. You can examine more than 200 causes in both adjusted and pre-adjusted numbers, rates, and percentages for 187 countries.

GBD Insight

What are the health challenges and successes in countries around the world?

GBD Heatmap

How do different health challenges rank across regions?

GBD Arrow Diagram

How has the burden of different diseases, injuries, and risk factors moved up or down over time?

GBD Uncertainty Visualization

Where do we have the best data on the different health conditions?

GBD Cause Patterns

What diseases and injuries cause the most death and disability globally?

 

healthy habits, nutrition, policy, storytelling

DH getting serious on healthy food policy

  •  getting rid of guilt lanes at supermarket checkouts
  • removal of confectionery and soft drinks from gondola ends
  • voluntary code to limit marketing (incl. use of cartoon characters) of HFSS to children
  • Lidl trials of juices and fresh fruit in checkouts attracted 20% higher footfall
  • a new pilot scheme in a Morrisons store in Salford, using cardboardboard cut-outs of local GPs in the fresh produce aisles delivered a 20% rise in the sales of fresh fruit and a 30% uplift for frozen fruit.

Tip: http://www.foodpolitics.com/2014/01/how-to-get-people-to-buy-healthier-food-cardboard-cutouts/

Source: http://www.thegrocer.co.uk/topics/dh-wants-new-deal-to-tackle-unhealthy-food-promotions/353654.article

DH wants new Responsibility Deal measures to tackle unhealthy food promotions

18 Jan 2014 | By Ian Quinn

Health cutout

Cardboard cut-outs of local GPs convinced Salford shoppers to buy 20% more fresh fruit

The government has given retailers and suppliers a “short window of time” to agree a voluntary clampdown on the promotion of foods high in fat, salt or sugar as it prepares to launch a new strategy to fight childhood obesity in the spring.

The DH claims supermarkets and suppliers can supply the final piece in the jigsaw in its Responsibility Deal if they support a raft of proposals, including getting rid of “guilt lanes” at checkouts and the removal of sweets and sugary fizzy drinks from gondola ends. It is also planning a new voluntary code to limit the marketing of HFSS products to children. Talks before Christmas between health secretary Jeremy Hunt, health minister Jane Ellison and CEOs of suppliers and all the major supermarkets focused on protecting children from obesity and Ellison said she was “hopeful” they would result in a “package of measures”. Dr Susan Jebb, chair of the Responsibility Deal food network, who was central to the talks, said: “We’ve challenged them to think what they might do from a long and wide-ranging list of ideas. We’re giving the industry a short window of time to come back with a response.” She said pressure was growing on the government to regulate if companies failed to respond to the calls. With pressure on the DH reaching fever pitch in the wake of this week’s alarmist reports, it wants a commitment to guarantee a minimum level of price and loyalty promotions for healthier options, the banning of cartoon characters on packaging of HFSS foods and restrictions on online promotions. This week, discounter Lidl promised to roll out its ‘Healthy Checkouts’ concept – an initiative first trialled last year – replacing unhealthy items with fresh fruit and juices at tills, claiming the trial stores attracted a 20% higher footfall. “I think it’s a bold move,” said Jebb. “What I find very encouraging is that they’ve done it in response to what their customers want and I think it sends a powerful message to other retailers.” “This is a huge opportunity for the industry to show that a voluntary strategy is the way to deal with the obesity crisis,” she added. “We’re tackling satfats, calories and salt, and the thing that would wrap it all up is something around promotions.” Meanwhile it was revealed this week that a new pilot scheme in aMorrisons store in Salford, using cardboardboard cut-outs of local GPs in the fresh produce aisles delivered a 20% rise in the sales of fresh fruit and a 30% uplift for frozen fruit.

healthcare, healthy habits, meaning, musings, nutrition, policy, storytelling

Eternal youth for just $43K per day – or just exercise and eat well????

This is funny, only because for the super rich, this seems like a feasible way forward… instead of eating well and exercising. A really interesting insight into how broken our thinking on health truly is.

https://ama.com.au/ausmed/eternal-youth-may-be-yours-just-43000-day

Eternal youth may be yours, for just $43,000 a day

21/01/2014

Like a bad fairy tale, scientists believe they have developed a way to stop people getting older, but at a cost that puts it out of the reach of all but the super-rich.

A team of researchers at the University of New South Wales, working in collaboration with geneticists at Harvard Medical School, claim to have unlocked the secret to eternal youth, and to have developed a compound they say not only halts the ageing process, but can turn back the years.

The catch is, the treatment is prohibitively expensive, with estimates it would cost the average 86 kilogram man $43,000 a day, and the average 71 kilo woman $35,500 a day.

The compound was developed based on an understanding of how and why human cells age.

A series of molecular events enable communication inside cells between the mitochondria – the energy source for cells, enabling them to carry out key biological functions – and the nucleus. The researchers found that when there is a communication breakdown between the mitochondria and the nucleus of the cell, the ageing process accelerates.

As humans age, levels of the chemical NAD (which initiates communication between the mitochondria and the nucleus), decline. Until now, the only way to arrest this process has been through calorie-restricted diets and intensive exercise.

But the researchers, led by University of New South Wales and Harvard University molecular biologist Professor David Sinclair, have developed a compound – nicotinamide mononucleotide – that, when injected, transforms into NAD, repairing broken communication networks and rapidly restoring communication and mitochondria function.

In effect, it mimics the results achieved by eating well and exercising.

“The ageing process we discovered is like a married couple. When they are young, they communicate well but, over time, living in close quarters for many years, communication breaks down,” Professor Sinclair said. “And just like a couple, restoring communication solved the problem.”

In the study, the researchers used mice considered equivalent to a 60-year-old human and found that, within a week of receiving the compound, the mice resembled a 20-year-old in some aspects including the degree of muscle wastage, insulin resistance and inflammation.

Professor Sinclair said that, if the results stand, then ageing may be a reversible condition if it is caught early.

“It may be in the future that your age in years isn’t going to matter as much as your biological age,” Professor Sinclair said.

“What we’ve shown here is that you can turn back your biological age or, at least, we think we have found a way to do that.”

The problem is, the compound is prohibitively expensive, at least at the moment.

It costs $1000 per gram to produce, and in tests so far it has been applied at a rate equivalent to 500 milligrams for every kilogram of body weight, each day.

Professor Sinclair admitted the cost was major consideration, and said the team was looking at was to produce the compound more cheaply.

As part of their research, the scientists investigated HIF-1, an intrusive molecule that foils communication but also has a role in cancer.

It has been known for some time that HIF-1 is switched on in many cancers, but the researchers found it also switches on during ageing.

“We become cancer-like in our ageing process,” Professor Sinclair said. “Nobody has linked cancer and ageing like this before, and it may explain why the greatest risk of cancer is age.”

Researchers are now looking at longer-term outcomes the NAD-producing compound has on mice, and suggest human trials may begin as early as next year.

They are exploring whether, in addition to halting ageing, the compound can be used to safely treat a range of rare mitochondrial diseases and other conditions, such as cancer, type 1 and type 2 diabetes, muscular dystrophy, other muscle-wasting conditions and inflammatory diseases.

The research was published in the journal Cell.

Kirsty Waterford

facts & data points, healthy habits, nutrition

Diabetes and the brain

  • Good summary on the state of understanding the strengthening relationship between glucose metabolism and dementia
  • Type 2 diabetes is a very strong risk factor for dementia – Alzheimer’s disease is sometimes referred to as “Type 3 diabetes”
  • It also results in brain atrophy
  • Metabolic syndrome is also implicated in dementia
  • High insulin in the body means lower insulin in the brain due to a reduction in BBB insulin receptors, and insulin helps clear toxic beta-amyloid from the brain
  • The key to lowering blood sugar and insulin is lose excess weight and exercise more
  • a diet high in high GI carbs and saturated fat is associated with higher unbound beta-amyloid fragments in their CSF. Subjects on lower GI carbs and low saturated fat had less

http://www.nutritionaction.com/daily/diabetes-and-diet-cat/the-effect-of-diabetes-on-the-brain/

The Effect of Diabetes on the Brain

Can high blood sugar lead to brain atrophy?

 • January 16, 2014
“Type 2 diabetes is a very strong risk factor for dementia,” says Jae Hee Kang, assistant professor of medicine at Harvard Medical School and the Brigham and Women’s Hospital in Boston. “Some people call Alzheimer’s disease type 3 diabetes.”

(In type 1 diabetes, blood sugar soars because the body makes no insulin, the hormone that acts like a key to allow sugar into cells. In the more common type 2 diabetes, blood sugar soars because insulin no longer works properly—that is, people are insulin resistant.)

Act now to download your FREE copy of Diabetes and Diet: Decoding Diabeteswithout cost or obligation.

“There’s no question that diabetes damages small blood vessels,” says David Knopman, professor of neurology at the Mayo Clinic in Minnesota.

It may also shrink parts of the brain. A recent study found more brain atrophy in 350 people with diabetes than in 363 people without the disease.

It’s not just those with diabetes who are at risk. People who have what doctors call “metabolic syndrome” also have a higher risk of cognitive decline. That’s roughly one out of three U.S. adults.

Their blood sugar levels are higher than normal, but not high enough to be diabetes. That gives them an increased risk of dementia.

And they may have high blood insulin levels because obesity—especially an oversized waist—has made them insulin resistant. (When insulin doesn’t work well, the pancreas responds by pumping out more.)

That may also spell trouble for the brain. Men with high blood insulin levels declined more on cognitive tests over three years than those with lower levels.

Why would high levels of insulin in the blood matter?

“High insulin in the body means lower insulin in the brain,” says Angela Hanson, a physician and senior fellow at the University of Washington School of Medicine.

That’s because, over time, high levels of insulin in the blood may shrink the number of receptors for insulin in the blood-brain barrier, allowing less to enter the brain, says Hanson. And insulin may help keep the brain healthy.

“Insulin helps clear toxic beta-amyloid out of the brain,” Hanson explains. “So if you put someone on a diet that increases brain insulin, you might have less of the toxic amyloid around.”

The key to lowering sugar and insulin in the blood—and presumably raising insulin in the brain—is to lose excess weight and exercise more.

But one pilot study suggests that it’s not just how much, but what you eat that matters.

Hanson and her colleagues assigned 20 older adults without mild cognitive impairment and 27 older adults with MCI to eat one of two diets. The LOW diet was low in saturated fat, and its carbs had a low glycemic index—that is, they didn’t cause a bump in blood sugar. The HIGH diet was high in saturated fat, and its carbs had a high glycemic index.

The HIGH diet was unusually high in saturated fat and sugar, but it wasn’t off the charts. “If you look at a fast-food combo meal, it’s got a sugary soda and a high-fat burger,” notes Hanson.

After four weeks, people who got the HIGH diet had higher levels of unbound beta-amyloid fragments in their cerebrospinal fluid (which bathes the brain and spinal cord), while people who ate the LOW diet had lower levels.

“The theory is that the beta-amyloid that’s not bound to fats or other lipids is free, and it’s free to wreak havoc, if you will,” says Hanson. “We believe it’s a more toxic form of beta-amyloid because it’s less likely to be cleared. But that’s hard to test in humans.”

The results seemed to fit with a finding from a similar, earlier study: the LOW diet raised insulin levels in cerebrospinal fluid (and presumably the brain), while the HIGH diet lowered insulin levels.

“A Western diet or obesity or other things that cause high blood insulin may decrease brain insulin,” says Hanson. “If you make someone less insulin resistant with weight loss or a diet, they may have more brain insulin.”

Until more studies are done, it’s too early to know if a diet lower in saturated fat and sugars can protect the brain. But the research is encouraging.

“The most striking finding from these studies was that you could change the brain chemistry of people who have mild cognitive impairment,” says Hanson.

“When I’m in my clinic, I can tell patients with MCI that if they eat a healthier diet and exercise, things might get better. That’s the message that keeps me going.”

Sources: J. Am. Geriatr. Soc. 56: 1028, 2008; Exp. Gerontol. 47: 858, 2012; Diab. Care 36: 4036, 2013; JAMA 292: 2237, 2004; N. Engl. J. Med. 369: 540, 2013; Eur. J. Pharmacol. 719: 170, 2013; Neuroepidemiol. 34: 200, 2010; JAMA Neurol. 70: 967, 972, 2013; Arch. Neurol. 68: 743, 2011.

healthy habits, nutrition, policy, politics

Tobacco, Firearms and Food

“But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?”

http://www.nytimes.com/2014/01/15/opinion/bittman-tobacco-firearms-and-food.html

The Opinion Pages
Tobacco, Firearms and Food

Mark Bittman Jan 14, 2014

Let’s say your beliefs include the notion that hard work will bring good things to you, that the golden rule is a nice idea though it may occasionally have limits, and that it’s more or less every person for him or herself. Your overall guiding force is not altruism, but you’re not immoral; you’re a good citizen, and you don’t break any major laws. This could describe many of us; most, maybe.

Now suppose you’re in the business of producing, marketing or selling tobacco or firearms — products known to sometimes kill others. You need not be a corporate executive or a criminal arms dealer; you might be a retailer of cigarettes, a person who sells them along with magazines, a marketer, a gun shop owner. In any case, your conscience is clear: you’re selling regulated legal products and, as long as you’re obeying the regulations, you’re doing nothing illegal. (“Wrong” is a judgment call.)

You sleep well, believing that the government would further regulate your product if it were necessary. And if regulations were to change, you’d change with them. But to act otherwise — to hold back your energy from production or sales just because of moral or social pressure — would be foolish, and put you at a competitive disadvantage.

For many years after knowing about the lethal nature of tobacco, our government did little or nothing to limit its consumption. That’s changed gradually in the last 50 years, and more dramatically since 1998, because of successful lawsuits and because the Food and Drug Administration often tries to pursue its mission. (For a variety of reasons not worth going into, firearms are more challenging to regulate. Let’s leave it at that for now.)

O.K., so suppose we pass legislation that discourages you from producing or selling tobacco or firearms while at the same time actively encouraging you — supporting you — to change to producing apples or cotton or washing machines or screwdrivers; as long as you could see a way to increase profit, you’d probably look at the new opportunity. After all, it’s not as if you wantto produce agents of death. You want to make the best living you can selling stuff that’s legal and that people want. Markets change, and flexibility is important, and the government can and does affect your business, even if it’s by inaction.

Now let’s apply this same way of thinking to the major food categories — and for the purposes of this discussion there are only three — and what it’s like to be a farmer or producer, or a manufacturer, processor, distributor, retailer of this stuff. Again, you’re agnostic about what you sell, but you’re profit-conscious. And the government can and does affect your business; it can help your business (“you didn’t build it yourself”) or hurt it, as it should if your business is harming others.

Let’s call the first food group industrially produced animal products. Producing and selling as much as possible is the way to go here, since the penalties for damage your product does to human and animal health and to the environment (including climate) are virtually nonexistent. You can treat the animals as you like and damn the consequences, from salmonella contamination to antibiotic resistance to water contamination to, of course, cruelty. There are even incentives, in the form of subsidized prices for animal feed.

The next group is most easily labeled junk food; you might call it “hyperprocessed.” This comprises aisles and aisles of “edibles” sold in supermarkets and restaurants, and is often “food” that’s unrecognizable as such, ranging from soda and other sugar-sweetened beverages to things like chicken nuggets and Pringles and tens of thousands of other examples. These are mostly made from commodity crops, especially corn, soybeans and wheat. Federal subsidies abound in many forms here, from direct payments (in theory, these are ending, to be replaced by a bizarre form of crop insurance) to the ethanol mandate to virtually unregulated land use that permits toxic overapplication of fertilizers and other chemicals. There is also that same failure to recognize the public health and environmental costs of what is probably the least healthy diet a wealthy nation could devise. You could even say that the Supplemental Nutrition Assistance Program (SNAP, usually called food stamps) acts as a subsidy to junk food, since nothing limits using food stamps for food that promotes disease. It’s worth noting that for the past century the bulk of university research, much of it paid for with tax dollars, has gone into figuring out how to increase the yield of the crops and processes that turn out this junk that sickens.

Then, in the third group, there’s everything else, from fruits and vegetables — absurdly called “specialty crops” by the Department of Agriculture — to animals raised in sustainable and even humane ways. But here, disincentives abound: farmers may be encouraged to allow some land to go fallow, but not to be planted in specialty crops, and research money, subsidies, insurance, market promotion and access to credit are directed toward industrial food production, distribution and sales. These inefficiencies make most of this real food, which is health-promoting and closer to environmentally neutral, appear to be more expensive. (Only “appear,” though. If you account for the costs of environmental and public health damage, industrially produced junk food and animal products actually cost more.)

One could imagine a government that encourages more life-giving (and less disease-causing) agriculture just as one can acknowledge that sanity prevails when government steeply taxes tobacco and encourages its farmers to move on to something else. (I’m not saying, by the way, that tobacco farmers have been treated fairly; much more could have been done — and still could be done — to help them transition to other profitable crops.)

Of course this is disruptive; change the status quo, and someone is hurt. But the public health disaster created by our commodity-pushing agricultural policies is only getting worse, and calls for the same kind of action in industrial agriculture that we’ve seen in tobacco and, to a lesser extent, in guns. That kind of action will happen only when we have political representatives who care about food, health and the environment.

We can pressure corporations all we want, and what we’ll get, mostly, is healthier junk food. Really, though, as long as sugar is profitable and 100 percent unrestricted (and subsidized and protected!), marketers will try to get 2-year-olds hooked on soda and Gatorade.

But the job of government is not to encourage profitable businesses at the cost of public health; it’s to regulate them so that the public is served. Who is this country for, anyway?

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology

HICCUP: Health Initiative Coordinating Council

This manifesto aligns tightly with my own vision of how preventive health funding should be financed – data-driven and in a for-profit context.

HICCup

 

The HICCup experiment: Manifesto

Just imagine:

It’s 2019 and the mayor is having a bad day.  She wants to spearhead a new community program for bike-sharing, but she’s not sure the town can afford it.  Meanwhile, one of the new council members is pushing for an overhaul of the school lunch program.  She sighs as the assistant deputy mayor walks in.  “What now, Henry?” she asks with a slight edge in her voice.  But Henry is cheerful: “Mayor, I think we may have a way to fix this. I was just reading about the HICCup Experiment in a town just like ours…. It seems that if we did both the bike program and the school lunches, and made some other changes..”

“But what about our rising health care costs?” asks the mayor.

“That’s the point,” says Henry.  “HICCup showed that we can actually reduce those costs if we do multiple interventions simultaneously…even though none of them by itself would make a difference. And there’s an investment banker who just called us that’s eager to work with us to finance the project.  They’re asking us to set up a meeting with the big employers and Mercy Saints Health. Using the HICCup data, they think they can finance it all out of the health-care cost savings that would result, as long as we commit to following certain protocols.”

And the vision:

Now it’s 2040.  The mayor’s teen-aged son, also called Henry, is discussing his history project on the HICCup Experiment with other members of his MOOC.  “Of course,” he concludes, “the HICCup Experiment proved that multiple interventions can dramatically include the overall health of a community.  But the Experiment itself wouldn’t work anymore, as a funding vehicle.”

“Why not?” asks Susan, who clearly hasn’t done her homework.

Henry responds patiently with the obvious answer: “Because there are very few places with inflated, unnecessary health care costs anymore.”

The background

It is hard to find anyone in health care who does not believe that spending an extra $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $120 in lowered costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the plausibility and desirability of such an approach.

Yet neither individuals nor communities seem to act on the basis of this knowledge. Moreover, it’s likely that spending $110 now has no impact, as other factors dissipate any gain, but spending $110 million now (vs. a health-care budget of $100 million) should indeed return savings of $20 million annually over time.  Individuals often lack willpower or access to healthy food or convenient exercise facilities, and are surrounded by poor examples that encourage instant gratification rather than effort and restraint. And, on a broader, institutional scale, the money spent and the money to be gained do not belong to the same pocket.

Enter HICCup!

The goal of HICCup, the Health Initiative* Coordinating Council, is to facilitate the launch of five to eight community-wide experiments dedicated to proving that this can work, and to learning from both successful and unsuccessful efforts.  HICCup is a self-appointed counseling service and will persuade and guide local institutions to embrace a long-term perspective and launch a full-scale intervention experiment in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.   (*Yes, it used to be “health intervention…” but initiative is more friendly and positive, and still let us keep the logo!)

For starters, HICCup will focus on communities of 100,000 people or fewer. The majority of each community and its institutions must be enthusiastic for the initiative to gain traction. If the community members mostly work for just a few employers and obtain health care from just a few providers, that makes the effort of corralling the players easier. And, of course, you need community leaders – mayor, city council, and others – who will work together rather than undermine one another.

So, how will this be funded? Not by HICCup, which is only a coordinating body.  The trick is for an investor in each community to capture some of what is being spent already on health care. As a rough calculation, assume $10,000 in annual per capita health-care costs, or $1 billion per year in a community of 100,000. (There are also all the separate costs of bad health, which are much harder to count or capture.)  That money ultimately comes from individuals and employers who pay it in taxes, insurance premiums or direct payments; the place to intercept it is somewhere between the payers and the health-care delivery system.

Instead of spending $1 billion a year, imagine spending $1.1 billion the first two years, but, say, only $900 million in the fifth year (possibly a $300 million savings off projected costs of $1.2 billion by then). That sounds like an attractive proposition – but only if someone else will make that initial investment in return for a claim to those presumed later savings.  These numbers are just for illustration; figuring out actual and predicted numbers for each community will be a key task.

The first challenge is for each HICCup community to get the involvement of a benevolent but ultimately profit-driven billionaire or hedge fund, or a philanthropic fund that sees a way to do good while earning money for future goodness. There are a lot of billionaires out there, some with vision. There are health-care companies that might bite, hedge funds looking for large-scale projects, and so-called social-impact bonds. There also are large employers that might decide to work with other employers in certain communities.

The funder makes a deal with whoever is responsible for the health-care costs (buyers): The funder makes upfront investment in health interventions and pays the health-care costs, against continued payment from the health-care buyers of the $1-billion yearly baseline, with the funder to keep (most of) the savings against originally predicted rising costs in later years. The money may be paid by employers, private insurers (which collect it from individuals, who, in the United States, are now required to buy insurance) or from government health-care funds, which will be the trickiest source.

One way or another, the investor/experiment manager will need to figure out how to realign some of the sick-care facilities and workers to some other role, including prevention, serving outsiders or some other use entirely.  That’s the second challenge HICCup experimenters need to address – one that is being addressed in part by the creation of Accountable Care Organizations, but without community involvement in preventive health.

All together now!


All these entities will be taking a substantial leap of faith. But we believe they can succeed – especially if they work together through HICCup to figure out the numbers, study the effects of small-scale healthy-living/preventive health-care efforts, and encourage one another to move forward. Regardless, each investor must work with existing institutions – if only to get at the revenue stream initially and benefit from the lowered costs in later years.

Although grants are a nice source of funding for demonstration projects and research, the best way for HICCup’s vision to catch on and be widely copied is by adopting a for-profit approach that attracts broader investment once it is shown to work.  Indeed, if a benefactor makes a donation, they feel good when they send off the money. An investor feels good only after the investment actually pays off.

Community officials and voluntary organizations also need to sign on…or  they can drive the process and find the benefactor/investor. They will also contribute by implementing complementary changes in school meals and gym classes; enacting zoning and other changes to encourage cycling, walking, and the like; hiring health counselors and care workers; and perhaps working with local restaurants and food stores to subsidize healthy choices and discourage unhealthy ones.   Local media can report on the experiment’s progress, and each community will likely engage in healthy rivalry with other HICCup experimenters.

Though it won’t get to keep the direct health-care cost savings, each community will get all the ancillary benefits of a healthy population, including an enhanced reputation.  Indicators of population health include not just rates of obesity, diabetes, high blood pressure, and diseases and related costs, but also whether the elderly can live (and be cared for) at home, absenteeism, school grades and graduation rates, employment statistics, accidents, and the like. Although the funder keeps the reduction in health-care costs, the community gets the benefit in the many payoffs from a healthier population over time.

Open enrollment

HICCup will not choose which communities participate. They will be choosing them selves. HICCup’s role will be to advise them and help them to communicate and learn from other communities going through the same process. We also want to be a clearinghouse for vendors of health-oriented tools, services, and programs. There are many bargains to be struck between communities and vendors offering discounts in exchange for wholesale adoption of their tools or programs.

However, there is one unbreakable rule: To work with HICCup, communities must collect and publish a lot of independently vetted data (without personal information, of course). For starters, they will need benchmarks of current conditions and projected costs, and then detailed statistics on the adoption of the measures, their impact and costs, and what happens over time.  HICCup will welcome input from lawyers and actuaries!

It is now time to try this on a broad scale. Five years from now, we will wonder what took us so long to get started. So, again, who will those investors be?

healthy habits, nutrition, policy, politics

Big food go lite for the First Lady

  • Included only in the interests of balance, US big food exceeded a target to reduce calories – likely a modest, meaningless target, easily gamed? due to the GFC?
  • the denominator for the 6.4 trillion calories is 60.4 trillion calories
  • between 2007 and 2011, better-for-you, lower-calorie foods and beverages also drove financial performance for many of these same companies. Companies with a higher percentage of their sales coming from such products recorded stronger sales growth, higher operating profits, superior shareholder returns, and better company reputations.

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/01/major-food–beverage-companies-remove-6-4-trillion-calories–fro.html

Major Food, Beverage Companies Remove 6.4 Trillion Calories from U.S. Marketplace

Independent evaluation finds industry exceeded Healthy Weight Commitment Foundation pledge to remove 1.5 trillion calories by more than 400 percent.

January 9, 2014thumbnail

 

Princeton, N.J.—Sixteen of the nation’s leading food and beverage companies sold 6.4 trillion fewer calories in the United States in 2012 than they did in 2007, according to the findings of an independent evaluation funded by the Robert Wood Johnson Foundation (RWJF) and announced today. The companies, acting together as part of the Healthy Weight Commitment Foundation (HWCF), pledged to remove 1 trillion calories from the marketplace by 2012, and 1.5 trillion by 2015. The evaluation found that, thus far, the companies have exceeded their 2015 pledge by more than 400 percent.

The participating companies sold 60.4 trillion calories in 2007, the year defined as the baseline measurement for the pledge. In 2012, they sold 54 trillion calories. This 6.4 trillion calorie decline translates into a reduction of 78 calories per person in the United States per day. This is the first effort to track all the calories sold by such major companies in the American marketplace.

“It’s extremely encouraging to hear that these leading companies appear to have substantially exceeded their calorie-reduction pledge,” said James S. Marks, MD, senior vice president and director of the Health Group at RWJF. “They must sustain that reduction, as they’ve pledged to do, and other food companies should follow their lead to give Americans the lower-calorie foods and beverages they want.”

In October 2009, more than 40 of the nation’s largest retailers, non-profit organizations, food and beverage manufacturers and trade associations launched HWCF, with the goal of helping to reduce obesity, especially childhood obesity, by 2015. Sixteen companies participated in the calorie-reduction pledge, announced in May 2010 as one pillar of the work of HWCF. The pledge was part of an agreement between HWCF and the Partnership for a Healthier America, an independent, non-partisan organization dedicated to advancing the goals of First Lady Michelle Obama’s Let’s Move initiative by working with the private sector to end childhood obesity.

Together the 16 companies produced 36 percent of the calories from all packaged foods and beverages, items such as cereals, snacks, canned soups, and bottled beverages, sold in the United States in 2007. In 2010 the companies noted that, in order to meet the pledge, they likely would develop new lower-calorie options, change existing products so that they had fewer calories, and change portion sizes to introduce more lower-calorie packaging.

In order to evaluate the impact of the pledge, researchers at the University of North Carolina at Chapel Hill (UNC) combined data on foods and beverages sold by participating companies with nutritional information for those products. They then determined which individual products were included as part of the pledge and tracked sales of those products over time. All data used were publicly or commercially available. The full, peer-reviewed study is expected to be published later this year.

“The companies whose sales we analyzed have a big influence over the foods and beverages almost every American eats and drinks every day,” said Barry Popkin, PhD, the W.R. Kenan, Jr. Distinguished Professor in the School of Public Health at UNC, who is leading the evaluation team. “The evaluation system we’ve created will enable to us to determine how changes to what’s sold influences what people consume.”

Other research has shown that, between 2007 and 2011, better-for-you, lower-calorie foods and beverages also drove financial performance for many of these same companies. Companies with a higher percentage of their sales coming from such products recorded stronger sales growth, higher operating profits, superior shareholder returns, and better company reputations.

“Making the shift from traditional items to lower-calorie ones is not just the right thing for customers, it’s the right thing for these companies’ bottom lines,” said C. Tracy Orleans, PhD, senior scientist at RWJF. “The next big question is how these changes to what’s available on store shelves actually impact the health of children and families.”

The 16 companies committed to the HWCF calorie-reduction pledge include:

  • Bumble Bee Foods, LLC
  • Campbell Soup Company
  • ConAgra Foods (includes Ralston Foods)
  • General Mills, Inc.
  • Hillshire Brands (previously Sara Lee Corporation)
  • Kellogg Company
  • Kraft Foods Group/Mondelez
  • Mars, Incorporated
  • McCormick & Company, Inc.
  • Nestlé USA
  • PepsiCo, Inc.
  • Post Foods
  • The Coca-Cola Company
  • The Hershey Company
  • The J.M. Smucker Company
  • Unilever