Category Archives: complex adaptive systems

Medicity: Entering a new era of population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

http://www.healthcareitnews.com/news/entering-new-era-population-health?single-page=true

Entering a new era of population health

We have reached an inflection point in the history of health IT

In the six years since it became law, the HITECH Act has done much to advance the use of health information technology. And although the process of collecting and sharing health data has not yet significantly impacted care costs or quality, it has laid an important foundation for us to move toward population health management.

[See also: Population health success depends on good data]

There are important discussions underway to determine what’s needed to leverage health data to improve clinicaloutcomes and lower costs, and to extend those benefits across entire patient populations. Intelligent tools for population health will enable improvements in care quality, clinical outcomes and care cost.

Working through issues around health data exchange and patient engagement indicate the next challenges. We must construct a platform that will enable innovation in population health and analytics to thrive.

[See also: Pop health analytics top ACO priority]

Federal entities responsible for overseeing health and the healthcare industry in general are advancing rapidly toward a vision of interoperability and data sharing.

Congress taking a look

Congress is taking both near- and long-term actions regarding health IT innovation and standards. Near-term examples include recently directing the Office of the National Coordinator to report progress around interoperability and data sharing, and asking the Government Accountability Office to report on health information exchanges.

Congress has also launched the “21st Century Cures” initiative to help laws keep pace with health innovation. Among other measures, this initiative would consolidate meaningful use, quality reporting and value-based payments into one program – potentially the most significant move related to population health by Congress to date.

Federal Health IT Strategic Plan and Interoperability Roadmap

This past December, the Department of Health and Human Services released the Federal Health IT Strategic Plan, a coordinated effort among more than 35 federal departments and agencies to advance the collection, sharing and use of electronic health information – the cornerstones of population health management.

The HHS plan’s data-sharing section references the ONC’s Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, which was released at the end of January. The roadmap advances the ambitious goals to be reached by the end of 2017, including:

  • Establishing a coordinated governance framework and process for nationwide health IT interoperability;
  • Improving technical standards and implementation guidance for sharing and using a common clinical data set;
  • Enhancing incentives for sharing electronic health information according to common technical standards; and
  • Clarifying privacy and security requirements that enable interoperability.

In announcing the roadmap, HHS Secretary Sylvia Burwell called for “an interoperable health IT system where information can be collected, shared and used to improve health, facilitate research and inform clinical outcomes. This Roadmap explains what we can do over the next three years to get there.”

ONC Annual Meeting

At the February 2015 ONC Annual Meeting, titled “Interoperable Health IT for a Healthy Nation,” National Coordinator Karen DeSalvo, MD, told attendees that the agency’s focus is moving beyond meaningful use, toward interoperability and outcomes. This includes building out the IT infrastructure that will support health reform and enable better population health management.

A highlight of the ONC Annual Meeting was having all of the former national coordinators talk about the national state of health IT in the past, present and future.

David Brailer, MD, the nation’s first national coordinator, said the industry won’t be able to accomplish appropriate risk management, population health management or payment reform without interoperability. The ONC leaders shared a strong consensus that the intelligent use of technology will prevail in realizing population health goals.

Meaningful use is not dead

Despite the notion that it may be time to move beyond meaningful use, the program continues to drive electronic health record adoption, organizations have built incentive payments into their IT budgets and we continue to see program improvements.

At the time of this writing, proposed rules for Stage 3 meaningful user and 2015 Edition Standards and Certification Criteria were at the Office of Management and Budget for final review. The OMB announced of the proposed rules that “Stage 3 will focus on improving health care outcomes and further advance interoperability.”

Additional recent policy adjustments instituted or proposed include:

  • Simplifying satisfaction of the requirement for summary of care transmissions;
  • More realistic measures around the availability and actual viewing of patient information to satisfy patient engagement requirements; and
  • A potential new requirement to send electronic notification of significant patient health care events to patient care teams.

Measures such as these point to the importance of data sharing and enable achievable and meaningful progress toward population health management.

Payment models increasingly emphasize population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

As recently as 2011, Medicare made almost no payments through alternative payment models.

Among private payers, a group of major providers and insurers have formed the Health Care Transformation Task Force to shift 75 percent of operations to contracts designed to improve quality and lower costs by 2020. These very important public and private payer initiatives strongly underscore the need for critical health IT enablers of effective PHM.

Welcome to the new PHM era of health IT

We have reached an inflection point in the history of health IT, as we move beyond the HITECH era into this new era. We have come a long way in capturing health data, yet have only begun to share that data among providers, patients and payers. The opportunity ahead of us is to take major strides toward using that data to improve care and lower costs for the populace in general. We have been through an incredible decade of health IT. There is no sign of it slowing down.

Peter Hinssen: The Tiger and The Rock

EDxBrussels – Peter Hinssen – The TIGER & the ROCK

Why Extrapolating WON’T WORK & What it means for HEALTH http://www.tedxbrussels.eu About TEDx, x = independently organized event In the spirit of ideas worth…

http://wn.com/tedxbrussels_-_peter_hinssen_-_the_tiger_&_the_rock

8:20 – The Contiguous United States – macdonald’s proximity to people in the US

9:10 The Flip: Pharma moving to Health as a Service (no longer a product)

Institutions > Communities (trust)

Reactive > Proactive (attitude)

Hinssen_HealthMatrix

http://www.datapointed.net/visualizations/maps/distance-to-nearest-mcdonalds-sept-2010/

 

distance_to_mcdonalds_2010_l

Living to 150…

Most of the recent change in life expectancy has been that sick men are having their life with sickness prolonged.

https://www.mja.com.au/insight/2015/6/will-cairns-living-150

Will Cairns: Living to 150

Will Cairns
Monday, 23 February, 2015

HUMAN life expectancy will increase to 150 years within this century. Really?

When I was a GP I used to visit my frail elderly nursing home patients in my lunch break. Frequently I found them fast asleep in front of Days of Our Lives. This gave me pause for thought about how we live out our final years.

In the past few weeks it has been interesting to see a number of commentators suggesting that before the end of this century the advance of technology will enable some people to live on to the age of 150.

Among the evidence cited for this is the observation that the average life expectancy has increased from about 40 years to 80 years in the past 150 or so years and that this trend will continue.

The facts tell us otherwise. This Kaplan–Meier graph drawn up from several different life tables shows the proportion of the population who have remained alive over the 100+ years from their birth.

Over the past 200 years or so the application of scientific discovery — public health measures, improved nutrition and, lately, disease treatment — have almost stopped us from dying as children and prolonged our lives as mature adults.

However, our numbers plummet as we approach 100 years of age because all of these interventions make no difference to the reality that we eventually wear out and die. Apart from the odd unverified outlier, only one person has ever been confirmed as living for more than 120 years.

Life tables for the US dating back to the 19th century show the limits of modern technology to deal with the failings of old age:

US white males 1850 2005
Life expectancy at birth 38.3 77.4
Life expectancy at age 50 71.6 80.7

So, in the past 150 years, in the most powerful nation in the world with the best that modern technology and affluence can throw at the challenge, while the average life expectancy at birth has risen by 39.1 years, the life expectancy of a 50-year-old has increased by only 9.1 years.

It used to be that the highest mortality was among children; now it is among the elderly. A man aged 65 years living in the UK in 2004‒2006 could expect to survive for another 16.9 years, of which 10.1 years (59.8%) were deemed to be healthy.

Life expectancy of 65-year-old males in UK
2004-2006 2007-2009
Total 16.9 years 17.6 years
Disability free 10.1 years 10.2 years

While the life expectancy of a 65-year-old man increased by 0.7 years between 2004‒2006 and 2007‒2009, the healthy life expectancy has increased by 0.1 years. Most of the recent change in life expectancy has been that sick men are having their life with sickness prolonged.

There have always been at least a few people who avoided fatal infections, childbirth, accidents, wars, worn-down teeth, cancer, heart disease, or even just wearing out earlier, and have lived to be more than 100 before they slow down and die.

More of us become centenarians now because we don’t die of other things earlier, but there has been no significant increase in the maximum time that people can remain alive.

For most of us our maximum life expectancy remains less than 100 years, and for some far less. There is no evidence that modern technology has been able to stop even people who get no particular disease from just grinding to a halt when their time is up.

We have not been able to put more sand into our hourglass to increase the number of the days of our lives.

Talk of living to 150 is a distraction. The real challenge for the community as a whole is to accept the inevitability of death and to reintegrate that acceptance into culture.

As health workers and health care managers, we can all play a vital role in that process, both in how we communicate our understanding of death as a normal part of life and in how we incorporate it into the care of our individual patients.
Associate Professor Will Cairns is Director of Palliative Care in Townsville and author of the eBookDeath rules — how death shapes life on earth, and what it means for us.

* Australia 2008-2010 – Males
USA 2006
England/Wales 1838-1854 – Males
South Australia 1891-1900 – Males
Sweden 1816-1840
Modelled !Krung
Australia 1946-1948

Should we pay people to look after their health?

 

http://theconversation.com/should-we-pay-people-to-look-after-their-health-24012

Should we pay people to look after their health?

The key to using incentives may be to do so with a high enough frequency to create healthy habits. Health Gauge/Flickr, CC BY-SA

With the Tony Abbott government expressing concern about the growing health budget and emphasising personal responsibility, perhaps it’s time to consider some creative ways of curbing what Australia spends on ill health. One solution is to pay people to either get well or avoid becoming unwell in the first instance.

The United Kingdom is already doing this kind of thing with a current trial of giving mothers from disadvantaged suburbs A$340 worth of food vouchers for breastfeeding newborn babies. And from January 1 this year, employers in the United Statescan provide increasingly significant rewards to employees for having better health outcomes, as part of the Affordable Care Act.

But should people really be paid to make healthy choices? Shouldn’t they be motivated to improve their health on their own anyway?

Encouraging right decisions

People don’t do what’s in their best interest in the long term for many reasons. When making decisions we tend to take mental short cuts; we allow the desires and distractions of the moment get in the way of pursuing what’s best.

One such “irrationality” is our tendency to focus on the immediate benefits or costs of a situation while undervaluing future consequences. Known as present bias, this is evident every time you hit the snooze button instead of going for a morning jog.

Researchers have found effective incentive programs can offset present bias by providing rewards that make it more attractive to make the healthy choice in the present.

Research conducted in US workplaces, for instance, found people who were given US$750 to quit smoking were three times more successful than those who weren’t given any incentives. Even after the incentive was removed for six months, there was still a quit rate ratio of 2.6 between the incentive and control groups – 9.4% of the incentive group stayed cigarette-free versus only 3.6% of the control group.

A refined approach

Still, while research on using financial incentives to encourage healthy behaviours is promising, it isn’t as straightforward as doling out cash in exchange for good behaviour.

Standard economic theory posits that the higher the reward, the bigger the impact – but this is only one ingredient to success. Behavioural economics shows that when and how you distribute incentives can determine the success of the program.

Here are a few basic principles to consider. First, small rewards can have a big impact on behaviour if they’re provided frequently and soon after the healthy choice is made. We have found this to be true in the context of weight-loss programs, medication adherence, and even to quit the use of drugs such as cocaine.

Games of chance are an effective way of distributing rewards as research has found people tend to focus on the value of the reward rather than their chance of winning the prize. Many people think that a 0.0001 and a 0.0000001 chance of winning a prize are roughly equivalent even though in reality they are vastly different probabilities.

Finally, people are more influenced by the prospect of losses than by gains. Studies show people put much greater weight on losing something than gaining something of a similar value.

In one weight-loss experiment, for instance, participants were asked to place money into a deposit account. If they didn’t achieve their weight goals, the money would be forfeited, but if they were successful, the initial deposit would be doubled and theirs to keep.

Reluctant to lose their deposits, participants in the deposit group lost over three times more weight than the control group, who were simply weighed each month.

Creating good habits

Incentives are particularly effective at changing one-time behaviours, such as encouraging vaccination or attendance at health screenings. But with increasing rates of obesity and other lifestyle-related diseases, we need to focus on how incentives can be used to achieve habit formation and long-term sustained weight loss.

We know financial incentives can increase gym usage and positively impact weight, waist size and pulse rate, but how to sustain gym use after the incentive is removed? The key may be to use incentives to achieve a high frequency of attendance for long enough to create a healthy habit.

We also need to consider how we can leverage social incentives, such as peer support and recognition, together with new technologies to maximise the impact of incentive-based programs.

Innovative solutions, like paying people to encourage the right health choices, may help to reduce both the health and economic impact of Australia’s growing burden of disease.

Okham’s Razor – Limits to Growth – Kerryn Higgs

“The conscience and intelligent manipulation of the masses is an important element in democratic society. Those who manipulate this unseen mechanism constitute an invisible government that represents the true ruling power of our country. It is they who pull the wires that control the public mind.” Edward Bernaise (Sigmund Freud’s Cousin, Founder of modern PR)

http://www.abc.net.au/radionational/programs/ockhamsrazor/limits-to-growth/6088808

Limits to growth

Sunday 15 February 2015 7:45AM

Australian writer Dr Kerryn Higgs has written a book called Collision Course – Endless Growth On A Finite Planet, in which she examines how society’s commitment to growth has marginalized scientific findings on the limit of growth, calling them bogus predictions of imminent doom.

Transcript

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Robyn Williams: Growth or no growth? You may have heard Dick Smith on Breakfasta couple of weeks ago saying that unlimited growth is impossible and we must do something else. But what? There is, of course, a way of improving what we do more efficiently and stopping waste. Peter Newman from Perth gave an example on Late Night Live late last year: If we used trains instead of trucks for freight, it would halve the costs and save many, many lives. We don’t do it because we always do what we’ve always done. Kerryn Higgs, who’s with the University of Tasmania, has just brought out a book called Collision Course – Endless Growth on a Finite Planet, published by MIT Press and she has recently been appointed a Fellow of the International Centre of the Club of Rome.

 

Kerryn Higgs: I came across The Limits to Growth quite by accident in 1972, just when it was published. It was commissioned by the Club of Rome and written by a team of researchers at MIT, led by Donella and Dennis Meadows. The book changed the way I thought about Nature, people, history, everything. It persuaded me that physics matters, and that the idea of ever-expanding economic growth is a delusion. Up to then, I was a mainstream humanities person, history being my main discipline, and writing my passion. I did grow up in the countryside and loved the natural world, but I had no real intuition of an impending environmental crisis. And here was this little book suggesting that if we carried on with our exponential expansion, our system would collapse at some point in the middle of the 21st century.

 

Although galloping economic growth already seemed normal to most younger people living in the developed world in 1972, the growth that took off after WW2 was not normal. It is absolutely unprecedented in all of history. Nothing like it has ever occurred before: large and rapidly growing populations, accelerating industrialisation, expanding production of every kind. All new. The Meadows team found that we could avoid collapse if we slowed down the physical expansion of the economy. But this would mean two very difficult changes— slowing human population growth and slowing the entire cycle of physical production from material extraction through to the disposal of waste. The book was persuasive to me and I expected its message to have an impact on human affairs. But as the years rolled by, it seemed there was very little—and then, even less. In fact, I gradually became aware that most people thought “the Club of Rome got it wrong” and scorned the book as an ignorant tract from “doomsters”, an especially common view among economists. I want to point out, though, that recent research from Melbourne University’s Graham Turner, shows that the Meadows team did not get it wrong. Their projections for what would happen if we carried on business as usual tally almost exactly with what has actually occurred in the 40 years since 1972.

 

But while scientists from Rachel Carson onwards sounded alarm about numerous problems associated with growth, this was not the case in our govern­ments, bureaucracies, and in public debate, where economic growth was gradually being entrenched as the central objective of collective human effort. This really puzzled me.

 

How come the Club of Rome got such a terrible press?

 

How did scientists lose credibility? When I was young, science was almost a god. A few decades later, scientists were being flippantly brushed aside.

 

How did economists displace scientists as the crucial policy advisors and the architects of public debate, setting the criteria for policy decisions?

 

How did economic growth become accepted as the only solution to virtually all social problems—unemployment, debt and even the environmental damage growth was causing?

 

And how did ever-increasing income and consumption become the meaning of life, at least for us in the rich world? It was not the meaning of life when I was young.

 

Answering these questions took me back through human history. A few developments were especially decisive.

 

Around 1900, the modern corporation emerged. Over just a decade or two, many of the current transnationals came into being in the US (with names like Coca Cola, Alcoa and DuPont). International Harvester amalgamated 85% of US farm machinery into one corporation in just a few years. Adam Smith’s free enterprise economy was being transformed into something very different. A process of perpetual consolidation followed and by now, frighteningly few corporations control the majority of world trade and revenue, giving them colossal power. The new corporations of the early 20thcentury banded together into industry associations and business councils like the immensely influential US Chamber of Commerce, which was formed out of local chambers from across the country in 1912. These organisations exploited the newly emerging Public Relations industry, launching a barrage of private enterprise propaganda, uninterrupted for more than a century, and still very healthy today. Peabody coal, for example, recently signed up one of the world’s PR giants, Burson-Marsteller, for a PR campaign to convince leaders that coal is the solution to poverty.

 

Back in 1910 universal suffrage threatened the customary dominance of the business classes, and PR was an excellent solution. If workers were going to vote, they’d need the right advice. No-one expressed it better than Edward Bernays, Freud’s nephew, who is credited with founding the PR industry. Bernays was candid:

 

The conscious and intelligent manipulation of the… masses is an important element in democratic society (he wrote). Those who manipulate this unseen mechanism … constitute an invisible government which is the true ruling power of our country… It is they who pull the wires which control the public mind.

 

PR became an essential tool for business to consolidate its power right through the century, culminating in the 1970s project to “litter the world with free market think tanks”. By 2013, there were nearly 7,000 of these, all over the world; the vast majority were conservative, free market advocates, many on the libertarian fringe, and financed by big business. They cultivate a studied appearance of independence, though one think tank vice-president came clean. “There is no such thing as a disinterested think tanker,” he said. “Somebody always builds the tank, and it’s usually not Santa Claus or the Tooth Fairy.” Funding think tanks is always about “shaping and reshaping the climate of public opinion”.

 

Nonetheless, the claim to independence has been so successful that most think tanks have tax-free charity status and their staff constantly feature in the media as if they were independent and peer-reviewed experts.

 

Another decisive development was the “bigger pie” strategy. Straight after World War 2, governments took on a new role of fostering growth. The emphasis increasingly fell on baking a bigger pie, so the slices could get bigger but the pie would not have to be divided up any more equitably. Growth could function as an alternative to fairness. Thorny problems like world poverty were designated growth problems and leaders in the decolonising world often embraced a growth-oriented version of development, a version that rarely helped their poor majorities. Growth allowed the privileged to maintain and even extend their opulence, while professing to be saving the world from poverty. It’s frequently claimed that growth is lifting millions out of poverty. But, apart from China, this is not really the case. China has indeed decreased the numbers of its extreme poor, though this has been achieved with disastrous environmental decline and increasing inequality.

Meanwhile, progress is patchy elsewhere. After 70 years of economic growth, with the world economy now 8 to 10 times bigger than it was in 1950, there are still 2 and a half billion people living on less than $2 a day, more than a third of the people on earth, and about the same number as in 1981. Growth has not been shared. Underlying the popularity of growth, there’s a great clash of values between mainstream economics and the physical sciences.

 

Economists see the human economy as the primary system—odd when you consider that the planet’s been here for about 4.6 billion years, and life for something like 3.8 billion.  The human era is less than a whisker on this timescale, but for economists Nature is just the extractive sector of their primary system, the economy. For scientists and ecological economists, the primary system is the planet – and it’s self-evidently finite. The human economy with its immense material extraction and vast waste, exists entirely within the earth system. Self-evident as these boundaries might seem, they remain invisible or contested in mainstream economics and are of little concern to politicians or citizens in most countries. Hardly a news bulletin goes by without stories of growth expected, growth threatened, or growth achieved. Growth is the watchword of both major parties here and around the world and remains the accepted solution to poverty, pollution and debt.

 

And yet, however necessary growth is to our current economic arrangements, and however desirable from the point of view of our expectations of material well-being and comfort, it’s hardly a practical aim if it’s based on a misperception of reality.

 

While we assume that a high and increasing level of material consumption is normal and desirable, we ignore the peculiarity of our times and the encroaching threats to us and our planet.

 

We are well into dangerous territory in three areas:

 

Firstly, species are going extinct 100 to 1000 times faster than the background rate.

 

Secondly, the nitrogen cycle is completely disrupted. In nature, nitrogen is largely inert in our atmosphere. Today, mainly through making fertiliser, nitrogen is flooding through our rivers, groundwater and continental shelves, fuelling algal blooms that lead to dead zones and fish kills.

 

And thirdly we are on the way to a very hot planet. Unless we change rapidly in the extremely near future, we risk an increase of 4 degrees Centigrade by 2100. So far, an increase of less than 1 degree is melting the West Antarctic icesheet, glaciers nearly everywhere and even the massive Greenland icecap.

 

Meanwhile, the rate of carbon dioxide and methane emissions continues to rise. In fact, right through the decade it took to write my book, I was staggered as these emissions defied all protocols and agreements, and rose faster and faster every year, setting a new record in 2013. Four degrees may be a bridge too far, and yet our culture is cheerfully crossing it.

 

I started out as a student of human history and ended up studying the intersection between human history and natural history. Humans have had local effects for thousands of years but on a global scale, the collision is new. Humans were a flea on the face of the earth for most of our history andit’s probably true to say this is the very first time one species—ours—has taken over the entire planetary system for its own sole use. In human-focused terms, this may seem perfectly reasonable. In planetary terms, it’s weird and completely impractical.

 

While our best agricultural land, last remnants of white box woodland and the Great Barrier Reef are put at risk for the extraction of gas and coal, which we should aim to stop burning anyway if we want a liveable world, it seems that only citizen revolt is left to counter it.

 

Let’s hope we succeed.

 

The ground of our being is at stake.

 

Robyn Williams: Kerryn Higgs. She’s with the University of Tasmania and her book, published by MIT Press, is called Collision Course – Endless Growth on a Finite Planet.Kerryn has recently been appointed a Fellow of the International Centre of the Club of Rome. Next week I shall introduce the proud Professor who’s just moved into that crumpled brown paper bag designed by Frank Gehry for the University of Technology, Sydney: Roy Green on innovation in Australia and what’s not right.

 

Guests

Dr Kerryn Higgs
Writer
University Associate
University of Tasmania
Fellow of the International Centre of the Club of Rome

Publications

Title
Collision Course – Endless Growth On A Finite Planet
Author
Kerryn Higgs
Publisher
MIT Press

Credits

Presenter
Robyn Williams
Producer
Brigitte Seega

Comments (3)

Add your comment


  • Peter Strachan :

    12 Feb 2015 6:57:48pm

    Thanks Kerryn for outlining the problem and much of its genesis. I find it interesting and frustrating that the obvious solution to our predicament is not mentioned.

    If we have a citizens revolt, and I believe that we will eventually come to that, what direction would this revolt take society? Call me old fashioned but I was rather hoping that human intellect could come to a better solution than amorphous revolt against the status quo.

    As we look around at existing resource constrained parts of our planet, there are already many visions of that citizens revolt already underway. In the Middle East, in North Africa, Rwanda, in eastern Europe and recently even on our doorstep in The Solomon Islands overpopulation, lack of water and unequal distribution of wealth has led to civil unrest and war, often cloaked in ethnic or religious garb to disguise its true cause.

    The solution is already in our hands and its called family planning or contraception if you like.

    It is clear that humanity will not be able to avert expansion of societal collapse which has already shown its early phase, while its population numbers keep rising by 80 million pa. Yet there is an unmet desire by women and men to plan and reduce fertility rates. Why are we not providing free choice to those who want this? Why do we continue to promote high birthrates?

    Within a decade, population growth rates could be significantly reduced and begin a necessary decline towards a more sustainable level.

    But who, apart from Kelvin Thompson is leading the charge? Perhaps more people should know of www.populationparty.org.au?


  • Stephen S :

    14 Feb 2015 9:43:10am

    Gillard and Burke made sure that Labor’s 2011 ‘Sustainable Population Strategy’ contained little factual information and studiously avoided all these pressing questions.

    For another generation I fear, the opportunity was lost for a serious national debate about Australia’s rigid postwar policy of sustained high population growth.


  • Michael Lardelli :

    14 Feb 2015 3:05:22pm

    An interesting talk Kerryn. As to the “why” of the current obsession with economic growth, the fault is in us. While, as individuals, we pretend to rationality, humans, as a group, do not act in this way. As the products of evolution by natural selection, we act to maximise reproduction – and pity the person who tries to argue against that! For males, greater wealth gives us more access to females. For females, greater wealth gives higher social status and more probable survival of children.

    The fact is that we NEED to believe in economic growth because, without that, we are forced to face up to the falsity of what I call “The Big Lie” – namely that we can all improve our lives / get rich. I wrote an essay on this a few years ago:

    http://www.onlineopinion.com.au/view.asp?article=13487&page=0

    When people are young they can be idealistic and believe that they can change the world. But that would require that the world be a rational place.

    When people are older and more cynical like me they realise that human irrationality is a surging tide against which nothing can stand. It will wash over the world and then retreat. All radically new biological innovations thrown up by Nature are like this. Just like a newly evolved microorganism sweeps through a host population wreaking destruction until it – and the host – evolve to commensality, so the new and incredibly adaptable human species will do the same, although how many thousands of years that will take is unknown.

    In the meantime, those of us who understand the inevitability of this process can find some small amount of solace by attempting to change things in our local community to enhance the survival of our own children, friends, neighbours and communities. At the local level, the rational part of one human can sometimes make a difference. And there is no sense in getting depressed about the inevitable.

Establishing markets in prevention and wellness – 3 examples

1. AIA Vitality Life Insurance

  • https://www.aiavitality.com.au/vmp-au/
  • Wendy Brown – University of Queensland wbrown@hms.uq.edu.au
  • Tracy Kolbe-Alexander – University of Queensland

2. Data Driven Healthcare Quality Markets

3. Abu Dhabi Health Authority – Weqaya

 

 

Vitality Institute Commission – Recommendation 3 http://thevitalityinstitute.org/commission/create-markets-for-health/

Fat adults, fat kids, fat pets: how we’re driving the obesity pandemic

 

http://www.smh.com.au/national/health/fat-adults-fat-kids-fat-pets-how-were-driving-the-obesity-pandemic-20141205-120cbb.html

Fat adults, fat kids, fat pets: how we’re driving the obesity pandemic

 Science Editor

New research finds that obesity has become a major pandemic and looks set to get worse – in animals as well as humans, writes Nicky Phillips.

Bulging issue: Processed foods and climate change are hastening the obesity pandemic.Bulging issue: Processed foods and climate change are hastening the obesity pandemic. Photo: iStock

In the year 2000 when Cathy Freeman smashed the women’s 400-metre record at the Sydney Olympics, showcasing the best of our species’ physical abilities, the physique of many others crossed another, less auspicious line.

In that year the number of overweight people surpassed the number of people who were underweight.

While malnutrition remains a scourge in many parts of the third world, obesity elsewhere is now considered a pandemic – a global epidemic that has emerged in recent decades and costs Australia about $21 billion a year.

But it’s not just people battling the bulge.

The data is showing that pets and companion animals – such as cats, dogs and horses – have also dramatically increased in girth.

“There is something about our shared environment that is generating obesity in both humans and our companion animals,” says Professor David Raubenheimer, a nutritional ecologist at the University of Sydney’s Charles Perkins Centre.

A chief driver is economics, he says. Since the 1980s ultra-processed foods, which are cheaper than whole foods but far less nutritious, have flooded supermarkets and fast-food stores.

Climate change is also a factor, as higher concentrations of carbon dioxide diminish  the nutrient quality of plants and crops, which are the basis of human and many animals’ diets.

The idea that environment plays a major role in the obesity epidemic is not new. But Raubenheimer’s work is trying to unravel the complex mechanisms that make the modern world we’ve created for ourselves an uneasy fit for our bodies, which evolved in a very different landscape more than 100,000 years ago.

“It’s only by properly understanding problems that we can hope to predict, avert or manage them,” says Raubenheimer, who notes that not a single country has yet reversed its obesity epidemic.

To understand the role of the environment on obesity, there are a few things to note about our internal workings.

All animals, including humans, have sophisticated internal appetite systems that influence food intake to ensure the body receives the correct balance of each major nutrient group: protein, fat and carbohydrates.

Research by Raubenheimer and his colleagues found protein to be the most dominant of these nutrient “appetites”. Their studies in animals and people consistently show individuals will overeat fats and carbohydrates in order to meet their protein requirement.

Given that early humans evolved in an environment where meals likely consisted of lean game and root plants, both of which contained little fat or sugars, a strong protein appetite makes sense.

But now think of the modern world, where sugary, fatty and highly-processed foods – such as pizza, muesli bars, cereals, burgers and biscuits – are cheap and plentiful. Eating a greater quantity of those foodstuffs will not satisfy the protein appetite, but they are often consumed in place of protein because “protein costs more”, says Raubenheimer.

Studies in middle- and high-income countries consistently find that people living in poorer communities are more likely to be overweight or obese.

“The global rise of ultra-processed products, largely driven by powerful trans-national corporations, began in the 1980s and thus coincides closely with the period in which there has been a doubling in the rates of obesity,” wrote Raubenheimer, in his study published in theBritish Journal of Nutrition in November.

This may also suggest why dogs have beefed up by a whopping 33 percent, on average, and cats by 25 percent over the past few decades.

“If it’s more expensive to buy protein balanced foods for ourselves, imagine economically stressed families’ response when they feed their pets,” he says.

But it’s not just multinationals affecting food quality.

Climate change is diluting the nutrients in plants, because when exposed to high temperatures and a carbon dioxide-rich environment, the percentage of protein and fibre in plant leaves drops, while the concentration of sugars and starches increases.

“There is an immense amount of research showing that one consistent impact of climate change is the nutritional composition of plants,” Raubenheimer says.

Given that plants make up 80 per cent of the human diet, Raubenheimer predicts that vegetables and crops diluted of protein will become another factor in encouraging humans to overeat fats and carbohydrates to satiate their protein requirements.

Raubenheimer’s analysis suggests the impact of global warming on obesity rates will reach beyond plants to livestock animals that eat the plants, which people in turn consume as a major protein source.

If cattle and sheep graze on grasses with lower concentrations of the nutrient, they in turn will overeat to satiate their protein appetite, increasing their body weight, he says.

And while protein is a major driver of appetite, exposure to too much early in life may do more harm than good.

Numerous studies have found that babies fed formula, which has a higher concentration of protein than breast milk, are more likely to become obese later in life than breast-fed infants.

Raubenheimer says one explanation for this trend is that feeding infants high protein foods may be conditioning them to have a higher protein appetite for life.

“[This] is potentially causing those infants to overeat fats and carbs to a greater extent to satisfy their protein requirements,” he says.

While Raubenheimer and his collaborators at the Charles Perkins Centre know obesity emerges from a complex set of interactions between the environment, genetics and lifestyle factors, new approaches are desperately needed to tackle the problem, he says.

“We need interdisciplinary research, where approaches and concepts from multiple areas are applied to this major global crisis.”

Creating a Market for Disease Prevention

 

http://thevitalityinstitute.org/news/focus-on-pharma-creating-a-market-for-disease-prevention/

Focus on Pharma: Creating a Market for Disease Prevention

SustainAbility Newsletter “Radar” | Oct 30, 2014

Should pharmaceutical companies be in the business of producing pills, or of making people well? The answer is both. Elvira Thissen argues that with diminishing returns in medicines it is time for pharma companies to move away from philosophical discussions on prevention and adapt to new realities instead.

[…]

The Business Case for Prevention

A recent report by The Vitality Institute – founded by South Africa’s largest health insurance company – estimates potential annual savings in the US of $217–303 billion on healthcare costs by 2023 if evidence-based approaches to NCD prevention are rolled out.

At an estimated global cost of illness of nearly US$1.4 trillion in 2010 for cardiovascular disease and diabetes alone, there is a market for prevention. In the UK, the NHS spends 10% of its budget on treating diabetes, 80% of which goes to managing (partly preventable) complications. Reducing disease incidence represents a considerable value to governments, insurance companies and employers.

Some sectors are already eyeing the value of this market.

[…]

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