Category Archives: storytelling

Leeder: Exit from Medimuddle

 

http://www.australiandoctor.com.au/opinions/guest-editorial/hope-exists-beyond-the-government-s-medimuddle

Hope exists beyond the government’s Medimuddle

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Hope exists beyond the government’s Medimuddle

The start of a new year, in conjunction with the appointment of a new federal health minister, raises hope. An agenda of important health matters awaits her attention.

Incoming Health Minister Sussan Ley takes up her portfolio with strong professional experience in guiding education policy through community consultation in city and country. These skills should serve her well in the health portfolio.

Related News: 6 questions for the new health minister 

First, however, the ground must be cleared of the wreckage of the co-payment proposal.

Driven by ideology, uninformed by policy or accurate analysis of the health system, it was always going to be a debacle. In its latest manifestation, the co-payment plan, which will see doctors forego income, is festooned with a host of confusing exceptions.

It looks like a Scandinavian assemble-it-yourself gazebo built without instructions or an allen key.

But unfortunately it is no joke. Were it to quietly disappear, a sigh of relief would be heard across the land. However, it is proceeding amid a storm of justifiable anger from GPs.

Beyond this ‘Medimuddle’, there are actions of far greater substance needed to help secure the future of healthcare in Australia.

Related News: The new co-pay plan: full details

First, energy should be applied to clarifying for all the purpose of the health system and explaining how it has come to be. We need a narrative about why we invest public money in healthcare. We pay for Medicare to meet the needs of all Australians.

The equity thing — a ‘fair go’ — is an honoured Australian value. When it comes to healthcare, those who can pay more do so already. We recognise that much illness can strike anyone, and we seek to help those who get sick or injured. That’s the story of us, but we need to hear it retold quite often.

Chatter about the necessity for an additional price signal for healthcare, on top of the ones we have already, has never made sense.

We aim for a universally accessible system because as a society we care about the health of all our citizens. We care and value equity.

We are a remarkably altruistic community and we do not neglect those who need care simply because they are poor. We placed many wreaths recently because we care. This narrative needs to be clarified, corrected and repeated.

Second, because money does matter in health, waste should be rooted out. The principal areas of waste in healthcare are attributable to archaic management, most notably failure to apply IT where we can. Yes, we have done well in bringing the computer into the surgery and ward, and into pathology and radiology services. But there is so much more we can do to unite the fragments of healthcare by wiring them together.

Then there is the matter of lots of medical and hospital care provided in the face of evidence that it does no good or is unnecessary. The unnecessary parts should not be confused with humane care or time spent in doctor—patient communication, and in showing concern and compassion. That’s quite different.

Waste is not simply a matter of too much hi-tech machinery, but as was shown decades ago, the accumulated waste of doing and repeating far too many small-ticket investigations and prescribing little dollops of unnecessary medication (and this still includes unneeded antibiotics).

Waste is also to be found in the overpricing of generic pharmaceuticals where we continue to pay considerably more for many generics than is the case in, say, Canada.

To tackle this waste will require political skill in negotiating and implementing policy, because professional groups often become vigilant and aggressive custodians of the waste product and the income it generates.

Third, repair work is needed in general practice, especially where the co-payment train wreck blocks the tracks.

There is an urgent need to reduce red tape and improve quality of care in general practice, and to increase its availability in rural and regional Australia and on the edges of our cities.

Most economically advanced countries now recognise the critical importance of general practice in providing co-ordinated care and a medical home for the growing number of people with chronic health problems.

Damage to primary care harms both patients and the bottom line of the national health budget.

Health has many determinants — education, income, environment, diet, genes — and the healthcare system is complex. But these features are no excuse for the substitution of ideology and thought bubbles for a careful and steady approach to the changes needed to secure quality healthcare for all Australians.

Let 2015 be the year when health policy that enables this to occur reappears and is implemented.

Professor Leeder is an emeritus professor of public health and community medicine at the Menzies Centre for Health Policy in the University of Sydney.

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.

RWJF continues to go large on childhood obesity

 

 

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2015/02/rwjf_doubles_commitment_to_healthy_weight_for_children.html

Robert Wood Johnson Foundation Doubles Its Commitment to Helping All Children Grow Up at a Healthy Weight

RWJF dedicates a total of $1 billion since 2007 to ensuring that all children have access to healthier foods and opportunities to be physically active.

February 5, 2015

Princeton, N.J.―Recognizing that obesity remains one of the biggest threats to the health of our children, the Robert Wood Johnson Foundation (RWJF) today announced it will commit $500 million over the next ten years to expand efforts to ensure that all children in the United States—no matter who they are or where they live―can grow up at a healthy weight. Building on a $500 million commitment made in 2007, the nation’s largest health philanthropy will have dedicated more than $1 billion to reversing the childhood obesity epidemic. Encouraged by recent signs of progress in turning rates around, RWJF views this investment as critical to building a Culture of Health in communities across the United States.

With this new $500 million pledge, RWJF signals its commitment to expand and accelerate that progress, with an intensified focus on those places and populations hardest hit by the epidemic. New work will advance strategies that help eliminate health disparities that contribute to higher obesity rates among children of color and children living in poverty across the United States. The Foundation also announced an expanded focus on preventing obesity in early childhood and on engaging parents, youth and health care providers to be active champions for healthier communities and schools.

Over the last decade, RWJF has been a leader in supporting nationwide efforts to change policies and school and community environments in ways that make the healthy choice the easy choice for children and families. Working in partnership with other funders and leaders in a variety of sectors, key initiatives enabled schools nationwide to transform their campuses into healthier places for kids and helped communities expand access to nutritious foods and safe places to be active. States and cities ranging from California to Mississippi, and New York City to Anchorage, Alaska, have begun reporting declining childhood obesity rates.

“By 2025, we want to ensure that children in America grow up at a healthy weight, no matter who they are or where they live,” said RWJF President and CEO Risa Lavizzo-Mourey, MD. “We have made substantial progress, but there is far more to do and we can’t stop now. This commitment is part of the Foundation’s effort to build a Culture of Health in every community across the country. We all have a role to play in our homes, schools, and neighborhoods to ensure that all kids have healthy food and safe places to play.”

Building on work the Foundation has implemented previously, RWJF will support research, action and advocacy strategies focused on the following priorities over the next decade:

  • Ensure that all children enter kindergarten at a healthy weight.
  • Make a healthy school environment the norm and not the exception across the United States.
  • Make physical activity a part of the everyday experience for children and youth.
  • Make healthy foods and beverages the affordable, available, and desired choice in all neighborhoods and communities.
  • Eliminate the consumption of sugar-sweetened beverages among 0-5 year olds.

This new $500 million commitment represents a major investment in the Foundation’s broader effort to build a nationwide Culture of Health that enables all in our diverse society to lead healthier lives, now and for generations to come. Integral to building a strong Culture of Health is helping all children achieve and maintain a healthy weight to give them the strongest start toward a healthy future. This will require greater collaboration among businesses, government, individuals, and organizations to create communities that offer ample opportunities for parents and kids to make choices that help them live the healthiest lives possible.

RWJF’s new commitment follows a series of research reports showing progress toward reversing the childhood obesity epidemic. On a national level, childhood obesity rates have begun to level off, according to the Centers for Disease Control and Prevention (CDC). The CDC also released data last year showing rates may be decreasing among the nation’s youngest children. In addition, states from California to Mississippi and cities from Anchorage to Philadelphia have reported reductions in childhood obesity rates.

But these initial reports of declines follow decades of increases. Despite the recent positive news, more than one third of young people are overweight or obese—a rate far higher than it was a generation ago. African-American and Latino youth continue to have higher obesity rates than their white peers, even in most areas reporting overall progress. Among the cities and states reporting good news on obesity, only Philadelphia has measured progress toward narrowing disparity gaps. In that city, childhood obesity rates have declined overall, and the steepest drops have been among African-American boys and Latino girls, two groups with historically high obesity rates.

“The Robert Wood Johnson Foundation is in this fight for the long haul to ensure that all kids grow up at a healthy weight,” said Roger S. Fine, JD, chairman of the RWJF Board of Trustees. “With this new commitment, we look forward to working with existing and new allies to realize a future in which every child can live a long, healthy life.”

Since its 2007 commitment, RWJF has funded numerous efforts to help young people eat healthier foods and be more active. It helped the Healthy Schools Program of the Alliance for a Healthier Generation grow from supporting 231 schools in 2006 to now more than 26,000 schools that are transforming their campuses into healthier places where healthy foods and physical activity are available before, during and after school. It created Healthy Kids, Healthy Communities, a national program supporting community change efforts that made healthy eating and active living the easy choice in 50 sites across the country and served as a model for later federal funding. The Foundation also has funded independent evaluations of significant commitments by the food and beverage industry, which demonstrated progress by major companies to cut 6.4 trillion calories from the marketplace.

In addition to work by RWJF and its grantees, the last several years have seen a building national movement to address childhood obesity. First Lady Michelle Obama has made a significant commitment to solving the challenge of childhood obesity through her Let’s Move! initiative. Congress passed the Healthy, Hunger-Free Kids Act with a bipartisan vote in 2010, paving the way for the first significant update to school nutrition standards in 15 years and laying the groundwork for broader policy changes. Food, beverage, and fitness industry leaders, as well as many others, have made changes to their products and practices in order to better support children’s health. As progress continues and expands, sustained action across sectors will be essential to creating a healthier future for children.

ABOUT THE ROBERT WOOD JOHNSON FOUNDATION

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

http://www.rwjf.org/en/blogs/culture-of-health/2015/02/we_must_all_playar.html

We Must All Play a Role in Ending Childhood Obesity

Feb 5, 2015, 1:00 PM, Posted by Sen. Bill Frist, MD

A mother walking with her daughters on sidewalk
We all want our kids and grandkids to grow up happier and healthier than we did. Instead, today’s children are the first generation of young Americans to face the prospect of living their entire lives in poorer health and dying younger than previous generations.The reason is no mystery. Too many of our children – one in three, according to studies – are overweight. We are allowing, and in some ways encouraging, our kids to consume more calories, more sugar, more fat, more sodium. At the same time we’re enabling a more sedentary lifestyle. Running, jumping, skipping, dancing, biking – today’s children simply don’t move as much as they once did, making it that much harder to keep off the pounds.The childhood obesity epidemic is having a devastating affect on too many families. Obese and overweight children are sick more often. They too often endure prejudice and bullying at school, leaving them embarrassed and depressed. They miss more school. When they grow up, they have more difficulty leading productive work lives. And they are more likely to suffer from chronic illnesses directly linked to obesity, such as diabetes and heart disease.

William FristSen. Bill Frist, MD
All of society pays a stiff price for childhood obesity. Twenty percent of the United States’ total expenditures on health care can be linked to conditions associated with obesity. Obesity costs our society more than smoking or drinking.But there is reason for hope. Parents, educators, business leaders, government officials, health care professionals, and nonprofits have launched remarkable initiatives to end this epidemic. The Robert Wood Johnson Foundation has been a leader in these efforts, ever since its dramatic $500 million initiative in 2007 to reverse trends in childhood obesity. And there are signs that we are already creating a brighter future for our children.In the last two years the Centers for Disease Control and Prevention (CDC) have reported small but significant downward trends in the percentage of preschool-aged children who are obese. Those kids are less likely to be obese when they are in middle school, high school, and beyond.

How did we begin to alter a movement that once seemed impossible to stop? I like to think of it as a good old-fashioned American mix of families, educators, policy makers and businesses pulling together to bring about change. Parents are getting out and doing things with their kids – hiking, jogging, cycling, swimming, throwing a ball or Frisbee around – and both parents and kids find themselves feeling better. Schools are offering healthy lunch choices, and making good food, including breakfast, available for students who might otherwise be able to afford only junk food, or no food at all. Cities and states are requiring fast-food outlets to post nutrition information. Large retail chains are building fresh-food grocery stores that represent oases of healthy nutrition in “food deserts.” Hospitals and clinics are emphasizing preventive care programs. Foundations such as RWJF, with its efforts to build a Culture of Health, are promoting innovative pilot programs and partnerships. All these efforts, taken together, are truly making a difference.

But there’s no question that we have a long way to go. We can all do more, and we must do more, both individually, through our organizations, and in partnership with others. That’s why RWJF is pledging another $500 million over the next ten years to expand efforts to ensure that all children in the United States―no matter who they are or where they live―can grow up at a healthy weight.

What can you do? Take a kid bowling, or for a hike. Suggest alternatives to fried foods at the next covered-dish supper held at your church. Write your elected representatives expressing your support for programs to fight childhood obesity. Present a petition to the school board asking that physical education be reinstated or expanded, and that unhealthy snacks and drinks be removed. Ask the city council to ensure that all kids and families have access to safe parks and playgrounds. Donate money or volunteer your time to programs fighting childhood obesity. Buy and serve healthy foods for yourself and your family, and do your best to let everyone in the food chain know – from the local grocery manager to the big brand-name food companies to the farmer at the local greenmarket – that you want healthy, fresh food.

It’s been shown time and again, all across the country: If we make healthy food and exercise options easy and affordable, those are the choices that most families will make for their children. Please do your part to help America’s kids. Here at the Foundation, we’ll be supporting you all the way.

Bill Frist, a heart surgeon, is a former U. S. senator (R-Tenn) who has long been involved in promoting good health across America. He is a member of the Board of Trustees of the Robert Wood Johnson Foundation.

Working in partnership with other funders and leaders in a variety of sectors, key initiatives enabled schools nationwide to transform their campuses into healthier places for kids and helped communities expand access to nutritious foods and safe places to be active. States and cities ranging from California to Mississippi, and New York City to Anchorage, Alaska, have begun reporting declining childhood obesity rates

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/

Dr Atul Gawande – 2014 Reith Lectures

Lecture 1: Why Do Doctors Fail?

Lecture 2: The Century of the System

Lecture 3: The Problem of Hubris

Lecture 4: The Idea of Wellbeing

http://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-atul-gawande-2014-reith-lectures

Dr Atul Gawande – 2014 Reith Lectures

Atul Gawande, MD, MPH is a practicing surgeon at Brigham and Women’s Hospital and Professor at both the Harvard School of Public Health and Harvard Medical School.

In his lecture series, The Future of Medicine, Dr Atul Gawande will examine the nature of progress and failure in medicine, a field defined by what he calls ‘the messy intersection of science and human fallibility’.

Known for both his clear analysis and vivid storytelling, he will explore the growing importance of systems in medicine and argue that the future role of the medical profession in our lives should be bigger than simply assuring health and survival.

The 2014 Reith Lectures

The first lecture, Why do Doctors Fail?, will explore the nature of imperfection in medicine. In particular, Gawande will examine how much of failure in medicine remains due to ignorance (lack of knowledge) and how much is due to ineptitude (failure to use existing knowledge) and what that means for where medical progress will come from in the future.

In the second lecture, The Century of the System, Gawande will focus on the impact that the development of systems has had – and should have in the future – on medicine and overcoming failures of ineptitude. He will dissect systems of all kinds, from simple checklists to complex mechanisms of many parts. And he will argue for how they can be better designed to transform care from the richest parts of the world to the poorest.

The third lecture, The Problem of Hubris, will examine the great unfixable problems in life and healthcare – aging and death. Gawande will argue that the reluctance of society and medical institutions to recognise the limits of what professionals can do is producing widespread suffering. But research is revealing how this can change.

The fourth and final lecture, The Idea of Wellbeing, will argue that medicine must shift from a focus on health and survival to a focus on wellbeing – on protecting, insofar as possible, people’s abilities to pursue their highest priorities in life. And, as he will suggest from the story of his father’s life and death from cancer, those priorities are nearly always more complex than simply to live longer.

Five things to know about Dr Atul Gawande

Find out about Atul Gawande ahead of his 2014 Reith Lectures…

1.

In 2010, Time Magazine named him as one of the world’s most influential thinkers.

2.

His 2009 New Yorker article – The Cost Conundrum – made waves when it compared the health care of two towns in Texas and suggested that more expensive care is often worse care. Barack Obama cited the article during his attempt to get Obamacare passed by the US Congress.

3.

Atul Gawande’s 2012 TED talk – How do we heal medicine? – has been watched over 1m times.

4.

Atul Gawande has written three bestselling books: Complications, Better and The Checklist Manifesto.

The Checklist Manifesto is about the importance of having a process for whatever you are doing. Better focuses on the drive for better medicine and health care systems. Complications was based on his training as a surgeon.

5.

In 2013, Atul launched Ariadne Labs – a new health care innovation lab aiming ‘to provide scalable solutions that produce better care at the most critical moments in people’s lives everywhere’.

What Makes Gladwell Fascinating

 

https://www.linkedin.com/pulse/20131007120010-69244073-what-makes-malcolm-gladwell-fascinating

  Influencer

Wharton professor and author of GIVE AND TAKE

What Makes Malcolm Gladwell Fascinating

Suddenly, everyone wanted to talk about Malcolm Gladwell’s ideas, and I felt right at home. He made social science cool in watercooler chatter, spawning an entire genre of books that blend stories and studies to explain how the world works. He carried me through a decade of dinner parties with Blink and Outliers. With last week’s release of David and Goliath, I’ll be set for a while.

Gladwell refers to his books as “conversation starters,” and when people pick up that conversation, they often start criticizing his work. As a social scientist, I think this is a missed opportunity. I’m not saying that Gladwell’s writing is perfect or that his arguments are always true. I just want to make sure that we don’t throw out the baby with the bathwater, since we can learn as much from analyzing what he does right as from poking holes in his work. At a recent event, the discussion shifted away from the substance of Gladwell’s arguments, and toward the style: why is he arguably the most spellbinding nonfiction writer of our time?

The most popular explanation was storytelling skills: he’s a master of suspense, to the point that his books read like mystery novels. Some people waxed poetic about how he brings characters to life—who could forget the Six Degrees of Lois Weisberg or the tragic genius of Chris Langan? Others highlighted his ability to present sticky concepts that quickly make their way into the lexicon, like thin slicing, the 10,000 hour rule of expertise, and the magic number of 150 for social groups. And of course, his ability to illustrate social science with examples from popular culture loomed large in the discussion. Who wouldn’t want to read about how Hush Puppies took off, why Phantom of the Opera and Sesame Street hit it big, and what led Bill Gates and the Beatles to greatness? (There’s even a Malcolm Gladwell Book Generator website that plays on this notion by proposing new titles like Clarissa: How One Woman Explained It All; The Cheers Effect: How and Why Everybody Knows Your Name; and Lando: Intergalactic Lessons in Smoothness.)

If you believe that Gladwell’s success is primarily driven by his writing, I think you’ve overlooked the most important factor. What makes him most interesting is not the narratives themselves, but rather the ideas behind them.

In 1971, a sociologist named Murray Davis published a groundbreaking paper that opened with these two lines:

It has long been thought that a theorist is considered great because his theories are true, but this is false. A theorist is considered great, not because his theories are true, but because they are interesting.”

Davis argued that the difference between the dull and the interesting lies in the element of surprise. When an idea affirms what we already believe, we’re bored—we call it obvious. But when an idea is counterintuitive, we’re intrigued. Our curiosity is piqued, and we’re motivated to ask questions: how could this be? Is it really true? What else might this explain?

Challenging our assumptions is what Malcolm Gladwell does best. To see how he does it, let’s take a look at what Davis called The Index of the Interesting. Davis classified 12 different ways of challenging conventional wisdom, and Gladwell’s key ideas map beautifully onto at least five of them.

1. Bad is Good and Good is Bad

The idea here is to take a negative and unveil its positive side, or vice-versa. This is the theme of David and Goliath, where Gladwell argues that disadvantages can give us advantages. Who would have thought that a disability like dyslexia could actually make people more successful? With reasoning reminiscent of the Daredevil comic books, he illustrates how the absence of one ability—reading—can lead people to develop other abilities in areas like creative problem solving, acting, listening, and rule-bending. He presents data suggesting that losing a parent as a child, one of the worst things that can happen in life, may actually increase your odds of becoming president or prime minister. He also explores the other side of the coin, arguing that power led the British Army and Southern segregationists to underestimate uprisings in Northern Ireland and Alabama.

2. What Looks Like an Individual Phenomenon is Really a Collective Phenomenon

Another way to challenge assumptions is to show that what we think is caused by individuals is in fact caused by broader societal forces. This is the heart of Outliers. Gladwell argues that we think professional hockey and soccer players make it because of talent and hard work, but it’s really about being born a few months earlier than their peers. We assume that planes crash due to mistakes made by individual pilots, but it’s actually about the cultures in which they were raised. We believe Bill Gates and the Beatles achieved greatness because of their talents, but they had to be in the right place at the right time.

Gladwell does the opposite in The Tipping Point, arguing that major collective changes are actually fueled by small numbers of people. Styles and social movements catch on when connectors build bridges between people and ideas, mavens share expertise, and salesmen convince people to come aboard.

3. What Seems to Succeed Fails, and What Seems to Fail Succeeds

It’s interesting when something that appears to work doesn’t, or when something that looks ineffective proves to be effective. In David and Goliath, Gladwell covers evidence that contrary to popular belief, small classes in schools don’t lead children to learn more. In Blink, he adopts the reverse strategy, showing that although we expect reason to outdo intuition, we underestimate the power of intuition. We believe that the best way to spot fake art is through systematic analysis, but an expert can tell in the blink of an eye. Even when critical information is stripped away, and we only have tiny clues, our intuition can be strikingly accurate. A 10-second silent video clip is enough to spot an engaging teacher; an audiotape with the words garbled so that we can only hear the tone still allows us to identify the surgeon who was sued for malpractice; and a 15-minute conversation about taking out the garbage allows us to predict which marriages will fail.

4. What Appears To Be Local is Global

It’s also surprising when seemingly isolated events are in fact driven by common forces. This is another hallmark of The Tipping Point, which shows how the same kinds of dynamics can explain the spread of sexually transmitted diseases, pop culture trends, and crime sprees. We also see it in David and Goliath, where the willingness of underdogs to play by a different set of rules serves as a lens for illuminating events as diverse as the success of the American civil rights movement and an inferior basketball team with an inexperienced coach making the national championship. (The Gladwell Book Generator picks up on this theme too, with the faux title Nothing: What Sandcastles Can Teach Us About North Korean Economic Policy.)

5. What Looks Like Disorder is Actually Order

The ability to find structure in chaos is another quality of interesting theories, and this is a signature strength of The Tipping Point. We think fads come out of nowhere, but if we appreciate Gladwell’s three rules of epidemics—the law of the few, the stickiness factor, and the power of context—we can better understand the systematic factors that cause them to spread. Confusion also turns into clarity inOutliers, where the puzzle of why a man with genius IQ works as a bouncer is traced to his difficult upbringing, and in David and Goliath, where the mystery of the greatest medical breakthroughs in modern history is also informed by a difficult upbringing.

On Becoming Interesting

Of course, execution is important. Before presenting an idea, Davis observed that the author “articulates the taken-for-granted assumptions” of the audience, and only then reveals how the idea challenges these assumptions. This rhetorical strategy is visible in each Gladwell book: articulate what we currently think, and then present examples and evidence to show how our beliefs are incomplete, inadequate, inconsistent, or just plain wrong.

Interesting ideas are counterintuitive, but not all counterintuitive ideas are interesting. Davis warned that if we believe too strongly in an idea, we don’t want to see it questioned:

one must be careful not to go too far. There is a fine but definite line between asserting the surprising and asserting the shocking, between the interesting and the absurd… those who attempt to deny the strongly held assumptions of their audience will have their very sanity called into question. They will be accused of being lunatics; if scientists, they will be called ’crackpots’. If the difference between the inspired and the insane is only in the degree of tenacity of the particular audience assumptions they choose to attack, it is perhaps for this reason that genius has always been considered close to madness.”

Gladwell is very careful on this front. In David and Goliath, he intentionally avoided analyzing the Israel-Palestine conflict, knowing that it was a hot-button issue, and instead chose other conflicts that were more likely to intrigue than offend. At the same time, recognizing that his ideas need to have meaningful consequences, he addresses topics that matter to society. Gladwell writes about improving education and fighting crime, making planes safer and curing cancer, electing the right president and championing human rights. He also writes about ideas that matter to us as individuals. As Davis put it:

an audience will find a theory to be interesting only when it denies the significance of some part of their present ’on-going practical activity’… and insists that they should be engaged in some new on-going practical activity instead. If this practical consequence of a theory is not immediately apparent to its audience, they will respond to it by rejecting its value until someone can concretely demonstrate its utility: ’So what?’ ’Who cares?’ ‘Why bother?’ ’What good is it?’”

Gladwell’s books make us care. He challenges us to rethink how we raise our children, how we build our workplaces, and how we live our lives. He gives us hope that if we practice enough, we can become great musicians or athletes. That if an idea is worthwhile, we can make it take off. That if we change the way we evaluate people, we can overcome stereotypes and give disadvantaged people an equal chance. That if we face disadvantages of our own, we can draw strength from them.

The Dangers of Interestingness

Although it’s tempting to use the Index of the Interesting as a guide for developing an idea, Davis advised us not to do that. It works better as a mirror than a map. When we try to generate ideas in this formulaic fashion, it comes at the expense of creativity. Rather, the Index comes in handy once we have an idea: we can use it to explore different assumptions that we might be challenging. But this too proves difficult, Davis observed, because “assumptions about a topic” are often “too diverse or too amorphous” for any idea to be “universally interesting.” Perhaps Gladwell’s true genius lies here, in identifying common assumptions that lie just beneath the surface—beliefs that are so widely accepted, so taken for granted, that we don’t even know we believe in them.

The punch line from Davis is that interestingness is in the eye of the beholder. What’s fascinating to one audience is obvious to another. Over time, assumptions evolve, and reactions depend on the current assumptions of your audience. This means that if you successfully champion an interesting idea, it will eventually cease to be interesting, because everyone will believe it. And that’s why we need Malcolm Gladwell to keep writing new books.

Adam is a Wharton professor, an organizational psychologist, and the author of Give and Take: A Revolutionary Approach to Success, a New York Times and Wall Street Journal bestseller. Follow him here by clicking the yellow FOLLOW above and on Twitter @AdamMGrant

Photo: Pop!Tech/Flickr

Don’t give reasons for prices – it triggers a psychological reflex to regain control and bargain down the price

 

http://www.forbes.com/sites/stevemeyer/2015/01/09/the-1-reason-why-salespeople-leave-money-on-the-table/

The No. 1 Reason Why Salespeople Leave Money On The Table

Salespeople talk too much.

In an earlier article, I discussed a study suggesting salespeople would be more persuasive if they relied more on visuals than words. Here we’ll talk about what’s perhaps the most likely point in the selling process where salespeople say too much – and trigger the price bully that lurks in every buyer’s heart.

Courting is a little like sales, right? Imagine you’re a guy who’s been dating a woman for some time and you decide to propose. You want to close the deal. So you buy her a ring and take her to a nice restaurant. As you hand her the ring, you lay out, like bullet points, the five reasons you’re the guy for her.

What she wants is for you to let the ring, and the sincerity expressed in your misty eyes, do the talking. Laying out your value proposition at this point seems like desperation, or doubt. She’s thinking, “After all that courting, why does he think he needs to convince me? Or is he not convinced himself?”

How many times have you seen salespeople, just before a close, try to justify their price by revisiting the key benefits of their product or service? How many times have you succumbed to that urge yourself?

It’s a bad selling tactic. The research suggests you will trigger the same reaction in your prospect that our hapless Romeo triggered in his Juliet.

Justifying your price seems like common sense. If you’re going to ask someone to do something, how could it be a bad idea to remind them of the reasons? There’s actually a landmark study out there that seems to give credence to the idea. Unfortunately, most people completely misread its conclusions.

The study, called “The Mindlessness of Ostensibly Thoughtful Action,” was conducted in 1978. It observed how people waiting in line to use a copier responded when somebody at the back of the line tried to cut ahead. When the person simply asked to go first, 60% agreed. When the person said, “May I use the Xerox machine because I have to make a copy?” 93% said yes – even though the “reason” itself made no sense.

Based on this study, salespeople are often advised that there’s some mechanism in the human psyche that responds to reasons, and that enumerating them will improve close rates.

Problem is, there was a second part to that study. In Part 2 the researchers raised the stakes. They had the line-cutter say, for example, “I need to make 20 copies; can I go first?” Predictably, fewer people said yes, only 24%. When the line-cutter tried again, adding a bogus reason why he had to make 20 copies, the reason had no effect.

So that study showed that reasons work when the stakes are low but provide no benefit when they’re high, which they usually are in selling situations.

A more recent study showed that giving reasons not only doesn’t help, it actually hurts salespeople. Researchers analyzed two negotiations over the price of an apartment. With buyer Group 1, the sellers presented a price, then added justifications, pointing out that the building had an elevator and was in a desirable neighborhood. With buyer Group 2, they simply named the price and remained silent.

Buyer Group 2 didn’t bargain as hard and agreed to a higher price. Why? The researchers said the justifications made buyers in Group 1 feel they were being pushed into a corner, and that the seller was trying to do their thinking for them. And here’s what’s really interesting: The Group 1 buyers responded to justifications by coming up with reasons why the apartment wasn’t so great. “Yeah, that’s all true, but parking is a pain and there aren’t enough washing machines.”

The researchers described this pushback as a psychological reflex to regain control, which is the most powerful insight in this study. Justifications are perceived by the buyer as an attempt to take control. Just stating your price and remaining silent leaves the buyer in control. For whatever reason, buyers who feel they’re in control are less likely to undermine your value proposition and demand a lower price.

All that said, there is of course an appropriate time to lay out your value proposition – early in your discussions as you’re conducting discovery and mapping your product or service to customer needs. Just don’t do it late in the sales cycle when you’re negotiating price.

As hard as it may seem, you’ll get a higher price if you just say, “Here’s what it costs,” and then shut up.

You might want to go easy on the misty eyes though.

Cth DoH look to disinvestment in low value care

 

http://www.theaustralian.com.au/national-affairs/health/health-eyes-15bn-payoff-from-war-on-waste/story-fn59nokw-1227183948925

Health eyes $15bn payoff from war on waste

EXCLUSIVE – SEAN PARNELL – HEALTH EDITOR

Ten per cent of all health expenditure — as much as $15 billion a year — could be saved through a concerted effort to reduce wasteful programs, marginal treatments and avoidable errors, senior officials in the Department of Health have revealed. The department’s Strategic Policy Group was examining large-scale savings — including an evidence-based campaign of “disinvestment” in low-value programs, drugs and therapies — long before the Abbott government committed to its unpopular GP co-payment.

Documents obtained by The Australian under Freedom of Information laws show the group of deputy secretaries and other officials wanted to reduce spending on low-value interventions and get serious about combating avoidable side-effects, mistakes and infections.

“Members expressed strong interest in holding further discussions on the impact of waste and adverse events,’’ minutes from a November 2013 meeting state. “The discussions could be informed by work already under way in the department on disinvestment and by ongoing work by the Australian Commission for Safety and Quality in Health Care.”

Out of the public eye, the group — which reports directly to the secretary of the department — established an Optimising Value in Health Investment Working Group and talked with Treasury officials. The bureaucrats were keen to redirect money away from areas where there was minimal benefit and potential harm. The FOI documents shed new light on the workings of government and go some way to dispelling the myth that health bureaucrats have not recognised the need to pursue efficiencies and efficacy.

A department spokeswoman yesterday confirmed the work was ongoing. The Grattan Institute has called for more work to be done on the cost of hospital admissions and procedures, noting the cost of a hip replacement in NSW public hospitals varies by more than $16,000. It has estimated savings of $1bn a year from targeting such inefficiencies, as well as $500 million a year from workforce reform — making better use of highly skilled workers — and up to $500m a year through greater use of generic medicines. Some in government believe higher co-payments for drugs and services will make consumers spend less on unproven therapies and, with more of a financial stake in health, be more accepting of limits on access and subsidies.

There are questions about the cost of subsidising new and expensive drugs, especially those with few recipients and limited efficacy, with a Senate committee soon to report on the timing and affordability of access to cancer drugs.

The last federal budget committed to a controversial co-payment that has since been reworked. It also outlined plans to merge the safety and quality commission and five other agencies into a new Health Productivity and Performance Commission — a move that has already halted work on new performance reporting for emergency departments, elective surgery and infections — and replace Medicare Locals with a new primary care structure.

The budget did not take up the commission of audit’s recommendation for a broader, 12-month review of health policies and programs. The government has yet to finalise outstanding reviews into mental health, alcohol and drug services, after-hours GP services, super clinics and unproven natural therapies benefiting from the health insurance rebate. The government believed the health architecture established by Labor needed to be disassembled, price signals put in place for consumers, and growth opportunities given to the private sector before other savings could be pursued. Plans for a reworked $5 copayment — estimated to save $3.5bn by 2017-18 — will start to play out from Monday, when regulations setting new time frames for consultations come into effect.

The government wants GPs to focus on more serious cases, requiring longer consultations, but the Australian Medical Association has warned of $20 co-payments for shorter consultations. About 40,000 people have signed a petition against the copayment and new Health Minister Sussan Ley has yet to start the sales pitch, amid speculation the regulations could be disallowed by the Senate.

The Economist: The end of the population pyramid

http://www.economist.com/blogs/graphicdetail/2014/11/daily-chart-10?fsrc=scn/fb/wl/dc/vi/endofpopulationpyramid

Daily chart: The end of the population pyramid | The Economist

Graphic detail
Charts, maps and infographics
Daily chart

The end of the population pyramid

The shape of the world’s demography is changing

THE pyramid is a traditional way of visualising and explaining the age structure of a society. If you draw a chart with each age group represented by a bar, and each bar ranged one above the other—youngest at the bottom, oldest at the top, and with the sexes separated—that is the shape you get. The pyramid was characteristic of human populations since the day organised societies emerged. With lifespans short and mortality rates high, children were always the most numerous group, and old people the least. Now the shape of the global population is changing. Between 1970 and 2015 the dominating influence on the global population was the fertility rate, the number of children a woman would typically bear during her lifetime. It fell dramatically over the period, meaning that the world shifted from having larger to smaller families. The age groups start to become markedly smaller only about the age of 40, so the incline starts much further up the chart than with the pyramid. The shape looks more like the dome of the Capitol building in Washington, DC. Between 2015 and 2060 the biggest influence upon the population will be ageing. Small families are already becoming the norm, the fall in fertility is slowing down and now almost everyone is living longer than their parents—dramatically so in developing countries. So, by 2060, the dome will have come and gone and the shape of the population will look more like a column (or perhaps an old-fashioned beehive).

Read the full article from The World In 2015.