Category Archives: policy

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

BMJ: Can behavioural economics make us healthy

  • BE policies are by design less coercive and more effective than traditional approaches
  • It is generally far more effective to punish than to reward
  • Sticks masquerading as carrots – simultaneous, zero-sum incentives and penalties
  • References to policies which have and have not worked – but why can’t policy be research?
  • Conventional economics can therefore justify regulatory interventions, such as targeted taxes and subsidies, only in situations in which an individual’s actions imposes costs on others—for example, second hand cigarette smoke. But the potential reach of behavioural economics is much greater. By recognising the prevalence of less than perfectly rational behaviour, behavioural economics points to a large category of situations in which policy intervention might be justified—those characterised by costs which people impose on themselves (internalities), such as the long term health consequences of smoking on smokers.
  •  Is it fair to say that in a universal health care system, any preventable ill health imposes costs on others, as it is the tax payer who picks up the cost of treatment?
  • present bias: the tendancy for decision makers tend to put too much weight on costs and benefits that are immediate and too little on those that are delayed. Present bias can be used to positive effect by providing small, frequent (i.e. immediate) payments for beneficial behaviours e.g. smoking cessation, medication adherence, weight loss
  • “peanuts effect” decision error: the tendency to pay too little attention to the small but cumulative consequences of repeated decisions, such as the effect on weightof repeated consumption of sugared beverages or the cumulative health effect of smoking.
  • competition and peer support are more powerful forms of behaviourally mediated interventions

Care of Nicholas Gruen.

PDF: CanBehaviouralEconomicsMakeUsHealthier_BMJ

Similarly in Health Affairs: http://content.healthaffairs.org/content/32/4/661.short

healthy habits, policy

RWJF: How behaviour change really happens

From the video:

  • don’t set up to fail: start with well motivated and capable people
  • the only way to effect long lasting change is either via baby steps or change in the environment
  • agile fast fail / rapid iteration R&D methodology (common in silicon valley) is something health doesn’t do, but should

 

How Behavior Change Really Happens

BJ Fogg, director of the Stanford Persuasive Technology Lab, is a social scientist, innovator, and teacher who creates systems to change behavior. “If we can help people understand how behavior change really happens in the long-term, then I believe people can design some of their own solutions to have healthier behaviors.”  —BJ Fogg

If we want people to have healthy habits, we need to understand where these habits come from. BJ Fogg’s behavior model gives us a compelling understanding for how behavior change happens, and allows us to better see how our work could inspire these changes.”

What's Next Health Infographic: Who Will Change Their Behavior?
complex adaptive systems, policy

Health Affairs: Ageing research will deliver best ROI

  • “In the last half-century, major life expectancy gains were driven by finding ways to reduce mortality from fatal diseases. But now disabled life expectancy is rising faster than total life expectancy, leaving the number of years that one can expect to live in good health unchanged, or diminished. If we can age more slowly, we can delay the onset and progression of many disabling disease simultaneously”
  • The study also shows significantly lower and declining returns for continuing the current research ‘disease model’, which seeks to treat fatal diseases independently, rather than tackling the shared, underlying cause of frailty and disability – such as the aging process itself.
  • Indeed, lowering the incidence of cancer by 25% in the next few decades – in line with the most favourable historical trends – would barely improve population health over not doing anything at all, the analysis showed.
  • Further analysis showed the same is true of heart disease, the leading cause of death worldwide. The study shows that, with major advances in cancer treatment or heart disease, a 51-year-old can expect to live about one more year. A modest improvement in delaying aging would double this to two additional years — and those years are much more likely to be spent in good health.
    The increase in healthy years of life would also have an economic benefit of approximately $7.1 trillion over the next five decades, they added.
    “Even a marginal success in slowing aging is going to have a huge impact on health and quality of life,” said corresponding author S. Jay Olshansky of the School of Public Health at the University of Illinois-C hicago. “This is a fundamentally new approach to public health that would attack the underlying risk factors for all fatal and disabling diseases.”
    “We need to begin the research now,” he said. “We don’t know which mechanisms are going to work to actually delay aging, and there are probably a variety of ways this could be accomplished, but we need to decide now that this is worth pursuing.”
  • Several previous studies have already shown how we might age more slowly, they team noted. These have included studies of the genetics of “centenarians” and other long-lived people.
    Attempts to slow the signs of biological aging have also been achieved in animal models, using pharmaceuticals and also dietary interventions such as caloric restriction or supplementation. But until now, no assessment has been made of the costs and health returns on developing therapies for delayed aging, said the research team.

Source: http://content.healthaffairs.org/content/32/10/1698.abstract

Recent scientific advances suggest that slowing the aging process (senescence) is now a realistic goal. Yet most medical research remains focused on combating individual diseases. Using the Future Elderly Model—a microsimulation of the future health and spending of older Americans—we compared optimistic “disease specific” scenarios with a hypothetical “delayed aging” scenario in terms of the scenarios’ impact on longevity, disability, and major entitlement program costs. Delayed aging could increase life expectancy by an additional 2.2 years, most of which would be spent in good health. The economic value of delayed aging is estimated to be $7.1 trillion over fifty years. In contrast, addressing heart disease and cancer separately would yield diminishing improvements in health and longevity by 2060—mainly due to competing risks. Delayed aging would greatly increase entitlement outlays, especially for Social Security. However, these changes could be offset by increasing the Medicare eligibility age and the normal retirement age for Social Security. Overall, greater investment in research to delay aging appears to be a highly efficient way to forestall disease, extend healthy life, and improve public health.

Article: http://www.foodnavigator-asia.com/Policy/Is-research-on-delayed-aging-a-better-investment-than-cancer-and-heart-disease

Article PDF: Is research on delayed aging a better investment than cancer and heart disease_

healthcare, healthy habits, nutrition, policy, politics, rapid learning health systems

Economist Intelligence Unit – Rethinking Cardiovascular Disease Prevention

 

Source: http://www.economistinsights.com/healthcare/opinion/heart-darkness%E2%80%94fighting-cvd-all-mind

CVD prevention at population level, such as a “fat tax” or smoking ban, relies heavily on regulation. This is its greatest strength – it can compel healthy behaviour (or seat belt wearing) – but also its greatest potential weakness. It inevitably involves some degree of coercion, which runs the risk of paternalism.It need not involve regulation, however. The same human flaws that are exploited by the food industry to persuade us to buy certain items at the check-out can also be used to persuade us to act in the interests of our own health. The current UK government is attempting to turn psychological weakness into an advantage outside of the legislative framework.

Its Behavioural Insights Team, commonly referred to as the “nudge unit”, is designed to seek “intelligent ways” to support and enable people to make better choices, using insights from behavioural science and medicine instead of increased rulemaking. Many of these goals overlap with CVD prevention, from smoking cessation to encouraging kids to eat healthier foods and walk to school more often. Early successes have brought them to the attention of the Obama administration in the US.

Besides the difficulties of making positive lifestyle changes, non-adherence to treatment is another significant obstacle to effective CVD prevention. Even after suffering a CVD incident, some patients forget to take their medication; other patients opt not to complete a course of treatment for other reasons, ranging from concerns about costs, the inconvenience involved with travel, to feelings of despondency caused by depression and anxiety. At its most anodyne, individuals frequently stop taking drugs prescribed for prevention after they feel better and think themselves cured.

This is part of a much wider medical problem: in the rich world adherence to treatment for all diseases is around 50%. Recognising the commercial opportunities here, private enterprise is looking to play a greater role. Earlier this year a US company called WellDoc launched a smartphone product aimed at giving type 2 diabetics better management of their treatment, through tailoured advice and motivational coaching. In the UK, meanwhile, a start-up calledImpact Health is developing a similar health psychology smartphone product to increase adherence to treatment among sufferers of Crohn’s disease.

CVD patients stand to benefit from such development in medical technology, although they may have to wait a little while yet. Impact Health’s online platform requires patients to have a smartphone. For this reason the start-up is targeting Crohn’s first and not CVD. As David Knull, one of its directors, explains, the profile of the average sufferer is generally around 30 years old—far younger than the average CVD patient, and much more likely to have a smartphone.

Report source: http://www.economistinsights.com/healthcare/analysis/heart-matter

Report PDF: The heart of the matter – Rethinking prevention of cardiovascular disease

The heart of the matter: Rethinking prevention of cardiovascular disease is an Economist Intelligence Unit report, sponsored by AstraZeneca. It investigates the health challenges posed by cardiovascular disease (CVD) in the developed and the developing world, and examines the need for a fresh look at prevention.

The report is also available to download in German, French, Italian, Spanish, Portuguese (Brazilian) and Mandarin—see the Multimedia tab

Why read this report

  • Cardiovascular disease (CVD) is the world’s leading killer. It accounted for 30% of deaths around the globe in 2010 at an estimated total economic cost of over US$850bn
  • The common feature of the disease across the world is its disproportionate impact on individuals from lower socio-economic groups
  • Prevention could greatly reduce the spread of CVD: reduced smoking rates, improved diets and other primary prevention efforts are responsible for at least half of the reduction in CVD in developed countries in recent decades…
  • …but prevention is little used. Governments devote only a small proportion of health spending to prevention of diseases of any kind—typically 3% in developed countries
  • Population-wide measures like smoking bans and “fat taxes” yield significant results but require political adeptness to succeed. There is no shortcut for the slow work of changing hearts and minds
  • The size of the CVD epidemic is such that a doctor-centred health system will not be able to cope. Innovative ways for nurses and non-medical personnel to provide preventative services are needed
  • A growing number of stakeholders are involved in CVD prevention, sharing the burden with governments. Now, greater collaboration across different sectors and interest groups should be encouraged
  • Collaboration works when incentives of stakeholders are aligned, including business. Finland’s famed North Karelia project suggests better alignment of interests is crucial to a successful “multi-sectoral” approach

Cardiovascular disease is the dominant epidemic of the 21st century. Dr Srinath Reddy, president of the World Heart Federation

We know a lot about what needs to be done, it just doesn’t get done. Beatriz Champagne, executive director of the InterAmerican Heart Foundation

Action at the country level will decide the future of the cardiovascular epidemic. Dr Shanthi Mendis, director ad interim, management of non-communicable diseases, WHO

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

Living on the edge with Farzad

  • It’s not as simple as you give people information and they change their behavior.  It’s information tools that build on that data and build on communities and a much more sophisticated understanding about how behavior changes. What TEDMED is also great at, is understanding the power of marketing. People think of marketing of being about advertising, but marketing is the best knowledge we have about how to change behavior and all those intangibles, those predictably irrational insights, of how and why we do what we do.
  • It’s harnessing those, instead of having them lead to worse health – like present value discounting that leads to people wanting to procrastinate and eat that doughnut now instead of going to the gym. Or the power of anchoring, where we fixate on the first thing we see and won’t think objectively about the true risks of things. Or the herd effect, our friend is overweight and so we are more likely to be overweight.
  • All those nudges that are possible can be delivered to us ubiquitously and continuously, and we can choose to have them. It’s not some big brother dystopic vision. It’s me saying, ‘I want to be healthier, so I will do something now that will help me overcome and use my irrationality to help me stay healthy.  To me, that’s the neat new edge between mobile cloud computing, personal healthcare, behavioral economics, healthcare IT, data science and visualization, design, and marketing. It’s that sphere that has so many possibilities to get us to better health.

http://blog.tedmed.com/?p=4153

 

The exit interview: Farzad Mostashari on imagination, building healthcare bridges and his biggest “aha” moments

Posted on  by Stacy Lu

Farzad Mostashari, MD, stepped down from his post as the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services (HHS), during the first week of October, which was also the first week of the Federal partial shutdown. During his tenure, Dr. Mostashari, who spoke at TEDMED 2011 with Aneesh Chopra, led the creation and definition of meaningful use incentives and tenaciously challenged health care leaders and patients to leverage data in ways to encourage partnerships with patients within the clinical health care team.

Whitney Zatzkin and Stacy Lu had the opportunity to speak with Dr. Mostashari during his last week in office.

WZ: Sometimes, a person will experience an “aha!” moment – a snapshot or event that reveals a new opportunity and challenges him/her to pursue something nontraditional. Was there a critical turning point when you figured out, ‘I’m the guy who should be doing this?’

Yeah, I’ve been fortunate to have a couple of those ‘aha’ moments in my life. One of them was when I was an epidemic intelligence service officer back in 1998, working for the CDC in New York City. I’ve always been interested in edge issues, border issues; things that are on the boundaries between different fields. I was there in public health, but I was interested in what was happening in the rest of the world around electronic transactions and using data in a more agile way.

In disease surveillance we often look back — the way we do claims data now – years later or months later you get the reports and you look for the outbreak, and often times the outbreak’s already come and gone by the time you pick it up. But I started thinking and imagining: What if the second something happens, you can start monitoring it? In New York City the fire department was monitoring ambulance calls. I said, ‘Wow, if we could just categorize those by the type of call, maybe we’ll see some sort of signal in the noise there.’

When I was first able to visualize the trends in the proportion of ambulance dispatches in NYC that were due to respiratory distress, what I saw was flu.  What jumped out at me was the sinusoidal curve. Wham! At different times of year, it could be a stutter process – it would go up and you would see this huge increase, followed two weeks later by an increase in deaths. It was like the sky opening up. The evidence was there all along, but I am the first human being on earth to see this. That was validation, for me, of the idea that electronic data opens up worlds. To bring that data to life, to be able to extract meaning from those zeros and ones — that’s life and death. That was my first ‘aha’ moment.

The second aha was after I joined New York City Department of Health, and I started a data shop to build our policy around smoking and tracking chronic diseases. What we realized was that healthcare was leaving lives on the table. There were a lot of lives we could save by doing basic stuff a third-year medical student should do, but we’re not doing it.  Related to that – Tom Frieden had a great TEDMED talk about everybody counts.

I said, ‘I want to take six months off and do a sabbatical, and see if there’s anything to using electronic health records to provide those insights, not to save lives by city level, but on the 10 to the 3 level – the 1,000 patient practice. That started the whole journey.  None of the vendors at the time had the vision we had, but we finally got someone to work with us and rolled this system out.  We called some doctors some 23 times, and did all the work to get to the starting line.  Finally, I took Tom on a field visit to see one of the first docs to get the program.

It was a very normal storefront in Harlem, and a nice physician, very caring, very typical.  I asked her what she thought of the program. She said, ‘It’s ok. I’m still getting used to it.’  I said, ‘Did you ever look at the registry tab on the right, where you can make a list of your patients? She said no.  I said, ok – how many of your elderly patients did you vaccinate for flu this year? She said, ‘I don’t know, about 80 to 85 percent.  I’m pretty good at that.’  I said, ‘o.k., let’s run a query.’  And it was actually something like 22 percent. And she said – this was the aha moment – ‘That’s not right.’

That’s generally the feeling the docs have when they get a quality measure report from the health plan. But that’s population health management — the ability to see for the first time ever that everybody counts. And being able to then think about decision support and care protocols to reduce your defect rate. That was the validation that we’re on to something. Without the tools to do this, all the payment changes in the world can’t make healthcare accountable for cost and quality if you can’t see it.

WZ: Everyone has that moment in life when they’re considering all of their career options. As you were considering medical school, what else was on the table?

I actually didn’t think I was going to go to medical school. I was at the Harvard School of Public Health. I was interested in making an impact in public health. I grew up in Iran, and thought I would do international public health work. And then my dad got sick; he had a cardiac issue. The contrast between the immediacy of the laying on of hands of healthcare, and the somewhat abstractness of international public health — the distance, the remove — tipped me into saying,  ‘You know, maybe I should go to medical school.’  I’ve been on that edge between healthcare and public health ever since, and always trying to drag the two closer to each other.

SL: Fast forward 20 years.  You’re giving another talk at TEDMED.  What’s the topic?

TEDMED and Jay Walker’s vision is more powerful in the futurescope, rather than in the retroscope. It’s more powerful to be where we are today and imagine a different future rather than look back and say, ‘Oh, yeah, we’ve done this.’  So what’s the future I would love to imagine?

The most exciting thing – as Jay Walker once mentioned in a talk comparing “medspeed” to “techspeed” – is to fully imagine what will happen if techspeed is brought to healthcare. Right now, there’s all this unrealized value that’s being given away for free that doesn’t show up on any GDP lists – what Tim O’Reilly called “the clothesline paradox.”  That kind of possibility brought to medicine, but where software costs $100,000 as opposed to free, and it evolves daily and is more powerful and quicker every day, and it’s beautiful and usable and intuitive, and that’s what people compete on.

And all of that is toward the goal of empowering people.  Someone said, maybe it was Jay at TEDMED, that a 14-year-old kid in Africa with a smart phone has more access to information than Bill Clinton did as President. Information is power, and it has changed everything but healthcare. For me the vision is breaking down that wall, so that patients can be empowered and can bind themselves to the mast to use what we’ve learned about how behavior changes.

It’s not as simple as you give people information and they change their behavior.  It’s information tools that build on that data and build on communities and a much more sophisticated understanding about how behavior changes. What TEDMED is also great at, is understanding the power of marketing. People think of marketing of being about advertising, but marketing is the best knowledge we have about how to change behavior and all those intangibles, those predictably irrational insights, of how and why we do what we do.

It’s harnessing those, instead of having them lead to worse health – like present value discounting that leads to people wanting to procrastinate and eat that doughnut now instead of going to the gym. Or the power of anchoring, where we fixate on the first thing we see and won’t think objectively about the true risks of things. Or the herd effect, our friend is overweight and so we are more likely to be overweight.

All those nudges that are possible can be delivered to us ubiquitously and continuously, and we can choose to have them. It’s not some big brother dystopic vision. It’s me saying, ‘I want to be healthier, so I will do something now that will help me overcome and use my irrationality to help me stay healthy.  To me, that’s the neat new edge between mobile cloud computing, personal healthcare, behavioral economics, healthcare IT, data science and visualization, design, and marketing. It’s that sphere that has so many possibilities to get us to better health.

The thing about the health is, we have a Persian saying: Health is a crown on the head of the healthy that only the sick can see. When you have it, you don’t appreciate it, but when you’re sick and someone you love is sick, there’s nothing better.  You would do anything to get that. We need to bring that vision of the crown to everyone and help each of us grab it when we can.

WZ: I noticed you closing your eyes while preparing to answer a question. How do you pursue being able to exercise your imagination, in particular while you’re sitting in a building that’s been marked for being the least imaginative?

Because the world, as it is, is too immediate and real and limiting, sometimes you have to close your eyes to see a different world.

What has been amazing has been to see that, contrary to what people expect, this building is filled with people with untapped, unbound, unfettered imaginations who are slogging through. They’re just trapped. You give them the opening, the smallest bit of daylight to exercise that, and they’re off and running.

I give a lot of credit to Todd Park as our “innovation fellow zero,” He saw the possibility that there are more than two kinds of people in the world, innovators and everybody else. For him, it was about going to create a space where outside innovators can be the catalyst or spark that elevates and permissions the innovation of the career civil servant at CMS in Baltimore. That’s been cool.

SL: What’s your bowtie going to do after you leave HHS?  Will we see it lounging on the beach in Boca?

I like the bowtie.  I think I’m going to keep it.  Perhaps the @FarzadsBowtie Twitter handle is going to go into hibernation, I don’t know.  I don’t control it. One of the things the bowtie does for me is help me remember not to get too comfortable.

I once said at the Consumer Health IT Summit – ‘You’re a bunch of misfits – glorious misfits. And I feel like I’m very well suited to be your leader. You know, I always felt American in Iran, and felt Iranian in America when I came here. I felt like a jock among my geeky friends, and like a geek among jocks. For crying out loud, I wear a bowtie!  I don’t have to tell you I’m a misfit.’

It’s that sense of not fitting into the world as it is. The world doesn’t fit me.  So instead of saying,  ‘I need to change,’ this group of people said, ‘The world needs to change.’ That’s the difference between a misfit and a glorious misfit.

The person who doesn’t fit into our healthcare system is the patient. The patient’s preferences don’t fit into the need to maximize revenue and do more procedures. The patient’s family doesn’t fit into the, ‘I want to do an eight-minute visit and get you out the door’ agenda. The patient asking questions doesn’t fit.  That’s the change we need to make. It’s not that we need to change. Healthcare needs to change to fit the patient.

Shortly following this interview, Dr. Mostashari left HHS and is now the a visiting fellow of the Engelberg Center for Health Care Reform at the Brookings Institution, where he aims to help clinicians improve care and patient health through health IT, focusing on small practices.

This interview was edited for length and readability.

complex adaptive systems, healthcare, healthy habits, policy, quotes & aphorisms, rapid learning health systems

Gamification in health…

  • people are more open to learning from a game than a powerpoint or clinician
  • fun, competition, and social networks all have positive affects on health and fitness behavior
  • “Practitioners still haven’t internalized the idea that we need to help people do the right thing. Not just by giving them the opportunity, but making them want to do it.”
  • “Designing engagement into social games is largely about manipulating dopamine response. Gamifying health allows us to hack into our natural feedback loops by engineering ways for us to get more dopamine for demonstrating good behavior.”

 

Source: http://www.medcrunch.net/whats-fun/ (via RWJF)

Gaming for Patient Treatment – What’s Fun Got to Do With It?

by  on Nov 6, 2013 • 8:48 pm

“People rarely succeed unless they have fun in what they are doing.” -Dale Carnegie

The Theory of Fun is an organization devoted to social experiments in fun. In one experiment, they turned a staircase next to an escalator into a piano to see whether people would still opt for the less physically challenging escalator. Not only did people choose for the fun piano staircase; they also went up and down the stairs multiple times (see the results here.) Playfulness has increasingly become incorporated into patient engagement and adherence. Additionally, creative tactics like video games that use fun, competition, and your social networks have shown positive affects on health and fitness behavior.

RM2 Customer 1 Gaming for Patient Treatment What’s Fun Got to Do With It?Paul Tarini, team leader for the Robert Wood Johnson Foundation’s Pioneer Portfolio, reported in 2010 that the collision of games and healthcare was inevitable. Featured that year at the Games for Health conference in Boston, MA, were dancing games for patients with Parkinson’s disease, or alternatives-to-smoking games on iPhones. Since, we’ve seen an unveiling of companies that develop games benefitting all sorts of conditions from anxiety and depression (SinaSprite byLitesprite) to games for kids with cancer (Re-Mission2 by Hopelab). The results have been significant and have illustrated how patients feel more inclined to accept and learn from a game about their condition than from, say, a PowerPoint or clinician. In Re-Mission2, results showed how players adhered to their treatment longer and more consistently after interacting with the game. Even more impressive, players had higher levels of chemotherapy in their body and so were literally responding to treatment better.

Michael Fergusson, founder and CEO of Ayogo Games, a social gaming production company based in Vancouver, believes games are the key to patient engagement and adherence. Practitioners, Fergusson says, “ still haven’t internalized the idea that we need to help people do the right thing. Not just by giving them the opportunity, but making them want to do it.”

Prescribed Fun: The Trick (or Science) of Adherence and Engagement

The World Health Organization (click for report) has said that people around the world will benefit more from adherence than from new therapy. Esther Dyson, an active investor in the digital health movement, has said, “It’s colossal stupidity that people aren’t healthier, because we know how to do it.” Yet, we don’t. Our own inability to do what we know we need to is the cause of many health care problems.

Perhaps social games can help. Social games are digital games played with your online social communities (like Facebook and Twitter). According to Ayogo Games: “Designing engagement into social games is largely about manipulating dopamine response. Gamifying health allows us to hack into our natural feedback loops by engineering ways for us to get more dopamine for demonstrating good behavior.”

A recent NPR article, “How Video Games Are Getting Inside Your Head – And Your Wallet”discusses how video game architects actively track children’s engagement with the game they’re playing. Inherent in any game design is research, tests, and analysis, all of which are imperative to making the game more fun, more engaging, and more likely to hold the player’s attention longer, and in some cases long enough to buy something.

The science of the brain and human behavior are integral to the success of a game. Many, especially parents trying desperately to get their kids outdoors, interacting with “real” things and “real” people, have more damning language about these studies than applauding. Indeed, most, when attributing the term “brain manipulation” to something, don’t have many nice things to say. Yet, looking at all this through a health care lens, if doing the same types of testing, tweaking and manipulation leads to positive and permanent change in health and fitness of an individual, it can’t be that bad, right?

Michael Fergusson believes this, and has created successful games where players’ health and behavior improve because of it.  One of Ayogo’s first health care games, Healthseeker, was for people living with diabetes, and the first health care game on Facebook. They had over 15,000 players. There were parts that were extremely successful, but other elements that weren’t. They reviewed the data and looked at what worked and what didn’t to see what design elements of the game brought players success in their health goals. What they found was players who consistently received incoming messages of encouragement from their online social networks had significantly greater chances of success. Putting friends and family into their application, Ayogo discovered, makes the game more meaningful. As a result, this design element has been brought forward into other game designs.

Team Fun 

“Man is most nearly himself when he achieves the seriousness of a child at play.” -Heraclitus

Outside of the digital space, Little Bit Therapeutic Riding Center provides equine facilitated therapy to children and adults with neurological, pyshological, and physiological disabilities. For the riders, working with horses provides an overwhelming sense of joy, and the therapy no longer becomes treatment-like. Instead, it’s fun and unpredictable. More, a rider’s experience of success is linked to the team supporting her efforts – her volunteers, her horse, and her instructor. Play, joy, laughter, excitement – they all have healing powers for our minds, bodies, and spirits – and the value of your community in sustaining all that cannot be underestimated, whatever the method.

“The experience of interacting with your own health can be dramatically affected,” says Fergusson. Because of this you want the design of the experience to engage as many people as possible so that embedded in the design, is an evolving conversation where people can learn together and improve the quality of life together. To this, Fergusson asks an interesting question: “There’s a question about who’s behavior you’re really trying to affect in social gaming – is it the person’s behavior or the community of that person?” Perhaps it’s both that need to change in order for engagement and adherence to really stick.

entrepreneurship, file note, healthcare, healthy habits, policy, rapid learning health systems, research methodology, technology

Healthy life years is the key selling proposition for funding NCD interventions…

Non-communicable disease presents an as-yet, unresolved health research challenge. But they may also lie at the heart of a similarly unresolved intergenerational, macroeconomic challenge.

To date, governments and academics around the world have sat back and carefully observed the epidemic of overweight, obesity, metabolic syndrome and diabetes overtake their communities.

The food industry has aggressively defended its turf, understandably resisting any calls for regulation in the absence of definitive evidence that these interventions will work.

Only the most courageous of politicians would ever embark on the regulation of such a powerful sector in the absence of evidence supporting efforts such as restricting advertising to children, mandating processed food composition, food labeling and taxing macronutrients know to be harmful.

So we find ourselves at an impasse that no one seems particularly able to break.

An emerging theme related to this issue is the idea that while the health system has succeeded in delivering extended life, it has not yet extended healthy life years. As such, the population still shudders at the thought of raising the retirement age past 70, even though average life expectancy now surpasses 80.

Non-communicable disease is considered a major driver of this divergence. As such, preventing non-communicable disease may represent an important challenge, not only driven by a health/moral imperative, but also for important economic reasons.

There are significant macroeconomic consequences of people not living most of their lives in a productive state of health. Most significant of these is the capacity of societies to sustain pensions when boomer-driven demographic shifts result in an increasing ratio of pensioners to tax payers.

This places life insurers, governments and superannuation funds into the medium- to long-term frame as key beneficiaries of addressing non-communicable disease.

This in turn makes them key targets for attracting investment capital to a venture addressing this concern.

Imagine a world where people lived healthy, vital, productive lives well into the 70s.

Too much?

Google have spotted this opportunity by investing $100Ms in a new start up called the California Life Company (CaLiCo). Its initial focus is on “ageing” with an early emphasis on genomics, epigenetics and a pharmaceutical fix.

I starting to think the answer is much simpler: Eat food, not too much, mainly plants. Move.

It’s about less, not more.

Establishing the evidence for this inkling, and then commercialising the insights gained is the inspiration behind Riot Health.

Stand by.

complex adaptive systems, cool, musings, nutrition, policy, politics, technology

I have no idea, I just write…

Punchy interview with Bill Gates’ favourite author. Alignment on food. Other things interesting, but unrelated.

http://www.wired.com/wiredscience/2013/11/vaclav-smil-wired/?mbid=synd_gfdn_bgtw

This Is the Man Bill Gates Thinks You Absolutely Should Be Reading

Author Vaclav Smil tackles the big problems facing America and the world.   Andreas Laszlo Konrath“There is no author whose books I look forward to more than Vaclav Smil,” Bill Gates wrote this summer. That’s quite an endorsement—and it gave a jolt of fame to Smil, a professor emeritus of environment and geography at the University of Manitoba. In a world of specialized intellectuals, Smil is an ambitious and astonishing polymath who swings for fences. His nearly three dozen books have analyzed the world’s biggest challenges—the future of energy, food production, and manufacturing—with nuance and detail. They’re among the most data-heavy books you’ll find, with a remarkable way of framing basic facts. (Sample nugget: Humans will consume 17 percent of what the biosphere produces this year.)His conclusions are often bleak. He argues, for instance, that the demise of US manufacturing dooms the country not just intellectually but creatively, because innovation is tied to the process of making things. (And, unfortunately, he has the figures to back that up.) WIRED got Smil’s take on the problems facing America and the world.

You’ve written over 30 books and published three this year alone. How do you do it?

Hemingway knew the secret. I mean, he was a lush and a bad man in many ways, but he knew the secret. You get up and, first thing in the morning, you do your 500 words. Do it every day and you’ve got a book in eight or nine months.

What draws you to such big, all-encompassing subjects?

I saw how the university life goes, both in Europe and then in the US. I was at Penn State, and I was just aghast, because everyone was what I call drillers of deeper wells. These academics sit at the bottom of a deep well and they look up and see a sliver of the sky. They know everything about that little sliver of sky and nothing else. I scan all my horizons.

Let’s talk about manufacturing. You say a country that stops doing mass manufacturing falls apart. Why?

In every society, manufacturing builds the lower middle class. If you give up manufacturing, you end up with haves and have-nots and you get social polarization. The whole lower middle class sinks.

You also say that manufacturing is crucial to innovation.

Most innovation is not done by research institutes and national laboratories. It comes from manufacturing—from companies that want to extend their product reach, improve their costs, increase their returns. What’s very important is in-house research. Innovation usually arises from somebody taking a product already in production and making it better: better glass, better aluminum, a better chip. Innovation always starts with a product.

Look at LCD screens. Most of the advances are coming from big industrial conglomerates in Korea like Samsung or LG. The only good thing in the US is Gorilla Glass, because it’s Corning, and Corning spends $700 million a year on research.

American companies do still innovate, though. They just outsource the manufacturing. What’s wrong with that?

Look at the crown jewel of Boeing now, the 787 Dreamliner. The plane had so many problems—it was like three years late. And why? Because large parts of it were subcontracted around the world. The 787 is not a plane made in the USA; it’s a plane assembled in the USA. They subcontracted composite materials to Italians and batteries to the Japanese, and the batteries started to burn in-flight. The quality control is not there.

Bill Gates’ actual bookshelf. We count six books by Smil in this section alone.   Ian Allen

Can IT jobs replace the lost manufacturing jobs?

No, of course not. These are totally fungible jobs. You could hire people in Russia or Malaysia—and that’s what companies are doing.

Restoring manufacturing would mean training Americans again to build things.

Only two countries have done this well: Germany and Switzerland. They’ve both maintained strong manufacturing sectors and they share a key thing: Kids go into apprentice programs at age 14 or 15. You spend a few years, depending on the skill, and you can make BMWs. And because you started young and learned from the older people, your products can’t be matched in quality. This is where it all starts.

You claim Apple could assemble the iPhone in the US and still make a huge profit.

It’s no secret! Apple has tremendous profit margins. They could easily do everything at home. The iPhone isn’t manufactured in China—it’s assembled in China from parts made in the US, Germany, Japan, Malaysia, South Korea, and so on. The cost there isn’t labor. But laborers must be sufficiently dedicated and skilled to sit on their ass for eight hours and solder little pieces together so they fit perfectly.

But Apple is supposed to be a giant innovator.

Apple! Boy, what a story. No taxes paid, everything made abroad—yet everyone worships them. This new iPhone, there’s nothing new in it. Just a golden color. What the hell, right? When people start playing with color, you know they’re played out.

Let’s talk about energy. You say alternative energy can’t scale. Is there no role for renewables?

I like renewables, but they move slowly. There’s an inherent inertia, a slowness in energy transitions. It would be easier if we were still consuming 66,615 kilowatt-hours per capita, as in 1950. But in 1950 few people had air-conditioning. We’re a society that demands electricity 24/7. This is very difficult with sun and wind.

Look at Germany, where they heavily subsidize renewable energy. When there’s no wind or sun, they boost up their old coal-fired power plants. The result: Germany has massively increased coal imports from the US, and German greenhouse gas emissions have been increasing, from 917 million metric tons in 2011 to 931 million in 2012, because they’re burning American coal. It’s totally zany!

What about nuclear?

The Chinese are building it, the Indians are building it, the Russians have some intention to build. But as you know, the US is not. The last big power plant was ordered in 1974. Germany is out, Italy has vowed never to build one, and even France is delaying new construction. Is it a nice thought that the future of nuclear energy is now in the hands of North Korea, Pakistan, India, and Iran? It’s a depressing thought, isn’t it?

The basic problem was that we rushed into nuclear power. We took Hyman Rickover’s reactor for submarines and pushed it so America would beat Russia. And that’s just the wrong reactor. It was done too fast with too little forethought.

You call this Moore’s curse—the idea that if we’re innovative enough, everything can have yearly efficiency gains.

It’s a categorical mistake. You just cannot increase the efficiency of power plants like that. You have your combustion machines—the best one in the lab now is about 40 percent efficient. In the field they’re about 15 or 20 percent efficient. Well, you can’t quintuple it, because that would be 100 percent efficient. Impossible, right? There are limits. It’s not a microchip.

The same thing is true in agriculture. You cannot increase the efficiency of photosynthesis. We improve the performance of farms by irrigating them and fertilizing them to provide all these nutrients. But we cannot keep on doubling the yield every two years. Moore’s law doesn’t apply to plants.

So what’s left? Making products more energy-efficient?

Innovation is making products more energy-efficient — but then we consume so many more products that there’s been no absolute dematerialization of anything. We still consume more steel, more aluminum, more glass, and so on. As long as we’re on this endless material cycle, this merry-go-round, well, technical innovation cannot keep pace.

Yikes. So all we’ve got left is reducing consumption. But who’s going to do that?

My wife and I did. We downscaled our house. It took me two years to find a subdivision where they’d let me build a custom house smaller than 2,000 square feet. And I’ll test you: What is the simplest way to make your house super-efficient?

Insulation!

Right. I have 50 percent more insulation in my walls. It adds very little to the cost. And you insulate your basement from the outside—I have about 20 inches of Styrofoam on the outside of that concrete wall. We were the first people building on our cul-de-sac, so I saw all the other houses after us—much bigger, 3,500 square feet. None of them were built properly. I pay in a year for electricity what they pay in January. You can have a super-efficient house; you can have a super-efficient car, a little Honda Civic, 40 miles per gallon.

Your other big subject is food. You’re a pretty grim thinker, but this is your most optimistic area. You actually think we can feed a planet of 10 billion people—if we eat less meat and waste less food.

We pour all this energy into growing corn and soybeans, and then we put all that into rearing animals while feeding them antibiotics. And then we throw away 40 percent of the food we produce.

Meat eaters don’t like me because I call for moderation, and vegetarians don’t like me because I say there’s nothing wrong with eating meat. It’s part of our evolutionary heritage! Meat has helped to make us what we are. Meat helps to make our big brains. The problem is with eating 200 pounds of meat per capita per year. Eating hamburgers every day. And steak.

You know, you take some chicken breast, cut it up into little cubes, and make a Chinese stew—three people can eat one chicken breast. When you cut meat into little pieces, as they do in India, China, and Malaysia, all you need to eat is maybe like 40 pounds a year.

So finally, some good news from you!

Except for antibiotic resistance, which is terrible. Some countries that grow lots of pork, like Denmark and the Netherlands, are either eliminating antibiotics or reducing them. We have to do that. Otherwise we’ll create such antibiotic resistance, it will be just terrible.

So the answers are not technological but political: better economic policies, better education, better trade policies.

Right. Today, as you know, everything is “innovation.” We have problems, and people are looking for fairy-tale solutions—innovation like manna from heaven falling on the Israelites and saving them from the desert. It’s like, “Let’s not reform the education system, the tax system. Let’s not improve our dysfunctional government. Just wait for this innovation manna from a little group of people in Silicon Valley, preferably of Indian origin.”

You people at WIRED—you’re the guilty ones! You support these people, you write about them, you elevate them onto the cover! You really messed it up. I tell you, you pushed this on the American public, right? And people believe it now.

Bill Gates reads you a lot. Who are you writing for?

I have no idea. I just write.