Monthly Archives: January 2014

data saving lives, entrepreneurship, healthy habits, musings, policy, quantified self, rapid learning health systems, technology

Location-based prevention services

OK, so here’s the idea:

Our physical environment is loaded with cues capable of triggering healthy and unhealthy behaviours…

  • walk past any take-away, and you might succumb to the call of a chicko-roll (or bottle of water)
  • approach the supermarket, and you might feel the urge to purchase a tub of ice cream (or bag of oranges)
  • do you take the escalator (or the stairs)

Rather than leaving it to fate, why not use a location-triggered message to steer away from temptation, and towards a healthy future.

The danger areas can be configured individually, crowd-sourced or pre-loaded, as can the messages.

business, management and leadership

How to really disrupt an industry: Get personal, make enemies, stay focused and delight customers

cute and semi-convincing…

http://www.startupsmart.com.au/growth/start-up-profiles/how-to-really-disrupt-an-industry-get-personal-make-enemies-stay-focused-and-delight-customers/2014011711517.html

How to really disrupt an industry: Get personal, make enemies, stay focused and delight customers

Friday, 17 January 2014 | By Rose Powell

Andy Sheats’ two-year-old, private health insurance start-up, health.com.au, has over 40,000 customers and is turning over $46 million each year. After cutting his entrepreneurial teeth at realestate.com.au, the start-up that transformed the property market, disrupting has become a tactic and a way of life.

Sheats spoke to StartupSmart about his top tips to disrupt industries in useful and profitable ways.

Disruption will always be volatile, so embrace it

Likening industry disruption to the French Revolution, Sheats says start-ups need to embrace the power shifts and volatility of creating change.

“What does industry disruption have in common with the French Revolution? The rich and comfortable get what’s coming to them when the people who are the foundation of their success realise they’ve been treated with contempt and act on it,” Sheats says.

For start-ups, the monarchy and upper class to be disrupted are high-margin industries resting on their laurels, who according to Sheats, need to be toppled.

“Why? Because complacency means they are not continually adjusting their products and services to meet the evolving requirements of their customers. Here’s news: this complacency plants the seed that will become a disruptor, and when it blooms those customers will leave.”

Use being little to your advantage

Describing disruption as “business model judo”, Sheats says start-ups need to pick their battles and make the most of their capacity to be nimble and responsive.

“Use the strength and power of a challenger against them – to turn a complacent business’s size, fat margins and momentum into a liability. An industry experiences disruption when this judo results in complacent businesses unable to economically respond due to their revenue or cost-structure,” Sheats says.

Large companies can struggle to change their products, services or processes as trends change and customer expectations evolve. Those who dominate less competitive industries are the most precariously placed for a smart start-up to take market share away from.

“An industry where there’s healthy competition and a lot of change and innovation is not flat enough to disrupt. Disruption only works because the incumbent is inadequate and enough customers are dissatisfied to switch to the new player, who offers something different,” he says.

Focus on the issue or gap, not the hefty competitor

As the virtue of disruption is better outcomes for customers, start-ups need to be smart about getting personal. By focusing on the people they want to serve, not the companies they’re trying to take them from, you’ll find the energy to keep going.

“A disruptor is a new player that identifies areas where current players really let customers down and finds a way to turn these chinks in the armour to their advantage,” Sheats says, adding sometimes what needs to be disrupted is people’s expectations about what’s possible.

“Use a new approach that unlocks untapped customer sentiment to reshape the industry in your favour. How you do that is by changing the status quo and continuing to challenge the status quo, even when you are the incumbent,” Sheats says, adding doing a thorough investigation of what your big competitor doesn’t do that your future customers want is a great starting point.

“We started by identifying what the incumbent insurers weren’t doing: with health.com.au, it was making health insurance more transparent and easier to understand and allowing customers to manage their policy online,” he says.

Below are Sheats’ five ways to do business like a disruptor:

  1. Question everything: The ‘it has always been done that way’ mentality should be a red rag to a disruptor. Don’t be afraid to probe and find out why. You can change ‘that way’.
  2. Focus on the customer: The people who switch from the incumbent to you do so because you serve their needs better, they are central to your continuing success.
  3. Do different things, and do them differently: Having a very clear unique selling proposition immediately becomes a hook that helps customers in their decision to switch to you.
  4. Fight on your ground: You’ll never win against the incumbent if you fight by their rules; they’re established and they have deep pockets. Change the rules by using their strengths against them, and then fight the battle in a context where you have the advantage.
  5. Keep innovating: As a disruptor you need to move faster, learn faster, and change faster than the incumbent. Your ability to continue to meet the needs of your customers this way is key.
healthy habits, policy

Health-Wealth effect…

Still, there is copious evidence around the world that obesity is a peculiar condition for poor people in rich countries. Less-developed countries have lower obesity, but in richer countries, there tends to be an inverse relationship between waistlines and bank accounts. It’s what researchers have called the “health-wealth” effect: Wealthier people tend to be healthier people. In the U.S., rich white women and poor black men have the lowest obesity rates (followed by rich white guys). America’s highest obesity rates by far are among poor minority women. A 2008 U.S. Department of Agriculture’s review of the effect of food stamps found obesity didn’t rise among children or men but did increase slightly among women.

 

http://www.theatlantic.com/business/archive/2014/01/where-does-obesity-come-from/283060/

Where Does Obesity Come From?

We think poverty makes people obese and that obesity makes people poor. It’s harder to understand exactly why.
Reuters

A new article by John Cawley in NBER Reporter, “The Economics of Obesity,”poses an interesting question right at the top. Why study obesity like aneconomic problem, anyway?

There are two broad answers. The first is simply methodological. Understanding the causes and consequences of obesity is hard because scientists like randomized experiments—e.g.: give one group drug X, give another group a placebo, and observe the difference. But this is almost impossible to do with weight. It’s unethical to randomly make participants obese just to watch what happens to them. So, it’s useful to study compare data and try to find out how income and obesity are actually related. Essentially: To study weight like an economist.

The second answer is that obesity is an economic problem, plain and simple. Obese Americans costs the U.S. $190 billion in annual medical costs attributable to their weight—or 20 percent of national health-care spending, according to Cawley’s research. That’s a shockingly high figure, and it implies that unpacking the relationship between income and obesity could save America even more money and anxiety than many researchers estimate.

The trouble is that, when it comes to obesity, practically nothing is clear-cut, starting with the word, itself.

Obesity is broadly defined by a body-mass index—a.k.a.: BMI, a ratio of height to weight—over 30. But not all weight is the same. There are variations of fat and muscularity that can make perfectly healthy, muscular men and woman technically obese. If you switch measures to body-fat percentage, the black-white obesity gap among women falls by half. If you switch to skin-fold thickness, scientists can predict obesity decades before your BMI crosses the 30 threshold.

Equally murky is whether being poor leads to obesity. Cawley’s own research didn’t quite find causality (there is “little evidence that income affects weight,” he writes).

Still, there is copious evidence around the world that obesity is a peculiar condition for poor people in rich countries. Less-developed countries have lower obesity, but in richer countries, there tends to be an inverse relationship between waistlines and bank accounts. It’s what researchers have called the “health-wealth” effect: Wealthier people tend to be healthier people. In the U.S., rich white women and poor black men have the lowest obesity rates (followed by rich white guys). America’s highest obesity rates by far are among poor minority women. A 2008 U.S. Department of Agriculture’s review of the effect of food stamps found obesity didn’t rise among children or men but did increase slightly among women.

So poverty might make some people obese, but obesity definitely makes many people poorer, through two broad channels: (a) it reduces take-home pay, particularly for women; and (b) it’s related to health conditions that reduce discretionary income, too.

If there is there is a close relationship between weight and poverty, it is strongest among women, from the peak of the 1 percent to below the poverty line. At the top, corporate boards appear severely biased against larger women in a way they don’t discriminate against larger men. Cawley’s research found that obesity lowers wages for all workers but particularly for white women. Women who are two standard deviations from normal weight (64 pounds for the typical woman) earn 9 percent less, he writes. Obese women are half as likely to attend college, 20 percent less likely to get married, and seven times more likely to experience illness, depression, or death from being overweight.

As Dan Engber wrote, unpacking the direction of causality here amounts to untying a Gordian Knot of interwoven effects:

Sickness, poverty, and obesity are spun together in a dense web of reciprocal causality. Anyone who’s fat is more likely to be poor and sick. Anyone who’s poor is more likely to be fat and sick.  And anyone who’s sick is more likely to be poor and fat.

Just about every easy solution to fighting obesity comes with an asterisk or a frightening medical warning. An extra hour-per-week of physical activity for fifth graders reduced obesity by 5 percent, according to Cawley’s research, but he couldn’t find a similar effect for children of other ages. In another experiment, Cawley introduced a workplace wellness program where colleagues deposited money and stood to receive payments for their weight loss. More than two-thirds of the participants had dropped out within a year, and the results showed practically no positive effect. In fact, the third of those still making deposits at year-end had lost, on average, just two pounds more than the control group. There are pharmaceutical solutions to weight-loss, but they, too, are more full of hope than success: “There is very little, if any, evidence suggesting that [weight-loss] products are effective, and some have potentially fatal side effects,” Cawley sums up.

The fact that obesity resists easy fixes—combined with the fact that it’s associated so strongly with low-income women—suggests that policymakers should perhaps look for solutions to its underlying causes and circumstances, like upscaling food deserts and redistributing income to alleviate poverty, which correlates so highly with obesity both in the U.S. and abroad. The very condition of poverty tends to focus the mind on immediate goals, which makes long-term planning (e.g.: diets) all but impossible.

But then again, one of the confounding aspects of the relationship between low wages and high obesity rates is that researchers like Cawley can’t show quite how one leads to the other. His conclusion is a reminder that for all the words and money spent deconstructing the origins of obesity, we’re still a long way from understanding which factors directly contribute to it—and, therefore, which factors to focus on to fight it. “It may never be possible to affirm with any degree of certainty the percentage of the rise in obesity attributable to specific factors.”

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

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

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

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

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

Director, Yale University Prevention Research Center

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

David L. Katz, MD, MPH

January 21, 2014  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

-fin

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

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

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

management and leadership

Composure in leadership

1.  Don’t Allow Your Emotions to Get in the Way
2.  Don’t Take Things Personally
3.  Keep a Positive Mental Attitude
4.  Remain Fearless
5.  Respond Decisively
6.  Take Accountability
7.  Act Like You Have Been There Before

http://www.forbes.com/sites/glennllopis/2014/01/20/7-ways-leaders-maintain-their-composure-in-difficult-times/

Glenn Llopis, Contributor 

1/20/2014 @ 10:18AM |86,841 views

7 Ways Leaders Maintain Their Composure in Difficult Times

leadership-composureLeaders need to show more composure than ever before in the workplace.   With the change management requirements, increased marketplace demands and intensifying competitive factors that surround us, leaders must have greater poise, agility and patience to minimize the impact of uncertainty.   How leaders respond to these and other growing pressures is an indicator of their leadership preparedness, maturity and acumen.

The composure of a leader is reflected in their attitude, body language andoverall presence.   In today’s evolving business environment, it is clear that leadership is not only about elevating the performance, aptitude and development of people – but more so about the ability to make people feel safe and secure.   Employees have grown tired of working in survival modeand thus want to be part of a workplace culture where they can get back to doing their best work without the fear of losing their jobs.

I worked with a colleague that lacked composure and was always in a panic.  Though he had tremendous credentials, he lacked the ability to remain calm and thus often made his employees feel uneasy. His leadership role was just too big for what he was capable of handling.   He was often too dramatic and the smallest of problems  launched him into crisis management mode.   Needless to say, his wasn’t an effective leadership that could deal with real crisis and change.    Because he was unable to reinvent himself and adapt to the unexpected, his tenure was short-lived.

The 21st century leader sees adversity through the lens of opportunity.  Rather than panic, a leader with composure takes a step back and begins to connect the dots of opportunity within adverse circumstances.   These types of leaders quickly detect the causes of adversity and solve for them immediately.  They then enable the opportunities previously unseen that could have avoided the adversity to begin with.  Many times crisis results when composure is missing.

The next time a problem arises, ask yourself if you or your leader could have shown a greater sense of composure and avoided the problem from surfacing.

When leading – especially during times of uncertainty and adversity, crisis and change – you must avoid showing any signs of leadership immaturity or lack of preparedness that will make your employees feel unsafe and insecure. Here are seven ways to maintain leadership composure during the most pressure-packed moments:

1.  Don’t Allow Your Emotions to Get in the Way

Seasoned leaders know not to wear their emotions on their sleeves.   They don’t yell or get overly animated when times get tough.  These types of leaders have such emotional self-control that even their body language does not give them away.

When you allow your emotions to get in the way, employees interpret this as a sign you are not being objective enough and too passionate about the situation at hand.  Strong-willed leaders can maintain their composure and still express concern and care, but not to the point that their emotions become a distraction – or that they can’t responsibly handle the issues at hand.

2.  Don’t Take Things Personally

Leaders shouldn’t take things personally when things don’t go their way.   Business decisions and circumstances don’t always play out logically because office politics and other dynamics factor into the process.    As a leader, remain calm and don’t get defensive or think that you always must justify your thinking and actions.

When you begin to take things personally, it’s difficult to maintain your composure and make those around you believe that you have things under control.  In fact, when leaders take issues too close to heart, they allow the noise and politics around them to suffocate their thinking and decision-making capabilities.

3.  Keep a Positive Mental Attitude

Employees are always watching their leader’s actions, behavior, relationships and overall demeanor.   During the most difficult of times, leaders must maintain a positive mental attitude and manage a narrative that keeps their employees inspired and hopeful.  This is where your leadership experience and resolve  can really shine – by staying strong, smiling often and authentically exhibiting a sense of compassion.

Leaders set the tone for the organization they serve.   A positive attitude can neutralize chaos and allow a leader to course correct through any negativity.    Employees feed off the attitude of these leaders during times of uncertainty.   Keep a positive mental attitude and never stop moving forward.  Stay focused on building positive momentum for the betterment of the healthier whole

4.  Remain Fearless

When leaders project confidence, they instill it in others.  During uncertain times, leaders must remain fearless and project a cool persona that communicates composure to those they lead.

I’ve been through ups and downs in my career and have learned that when you begin to fear adverse circumstances, you not only put yourself in a position of vulnerability, but it becomes extremely difficult to act rationally and objectively.    When you panic, you mentally freeze and your mind loses focus.

When you begin to get fearful, ask yourself:  What is the worst possible thing that can happen?  If you are objective about it and have the will and confidence to face it, you will eventually realize that the situation is manageable and can be resolved.  Faced with adversity several times over, your fears will eventually vanish and uncertainty will become your best friend.

5.  Respond Decisively

Leaders who maintain their composure will never show any signs of doubt.  They speak with conviction, confidence and authority – whether they know the answer  or not!  With their delivery alone,  they give their employees  a sense that everything is under control.

Recently, Mack Brown, the former coach of the University of Texas (UT) football team, was put under a lot of pressure to resign as a result of his team underperforming in 2013.  Though the University handled his forced resignation poorly  – considering Mr. Brown had coached the team successfully for the past 16 years – his decisiveness the day he announced his resignation made you feel that his transition out of the job was a positive thing for the university.  Human nature will tell you that he must have been hurting inside, but his decisiveness and presence of mind made those that were watching him speak believe that the future looked bright for UT football.

6.  Take Accountability

Leaders are most composed during times of crisis and change when they are fully committed to resolving the issue at hand.   When you are accountable, this means that you have made the decision to assume responsibility and takethe required steps to problem solve before the situation gets out of hand.

When leaders assume accountability, they begin to neutralize the problem and place  the environment from which it sprung on pause – much like New Jersey Governor Chris Christie did when he announced that he did not have any prior knowledge of the decision his aides made to close down access lanes to the George Washington Bridge.  Though there may be legal woes to come, the manner in which he handled the initial news conference (temporarily) neutralized the crisis – as he answered all of the reporters’ questions and took full responsibility and accountability to punish the perpetrators and keep something like this from happening again.  

7.  Act Like You Have Been There Before

Great leaders know that one of the most effective ways to maintain composure during difficult times is to act like you have been there before.   Leaders that act to show they have been through the problem solving process numerous times before are those with strong executive presence who approach the matter at hand with a sense of elegance and grace.    They are patient, they are active listeners, and they will genuinely take a compassionate approach to ease the hardships that anyone else is experiencing.

Just ask any technical support representative.  When you are on the phone with them, their job is to make you feel that even your most difficult challenges can be easily resolved.     They are there to calm you down and give you hope that your problem will soon be solved.    Pay attention to their demeanor and how they are masters at soothing your frustrations.  They always act to show that they have been there before; their composure puts your mind at ease.

It’s easy to lose composure during times of crisis and change if you let concern turn into worry and worry turn into fear.  By maintaining composure, the best leaders remain calm, cool and in control – enabling them to step back, critically evaluate the cards that they have been dealt and face problems head-on.  A show of composure also puts those you lead at ease and creates a safe and secure workplace culture where no one need panic in the face of adversity.

As the saying goes, “Keep Calm and Carry On!

cool, data saving lives, quantified self

Very cool – visualisation of all flights in the air live

http://www.theguardian.com/world/ng-interactive/2014/aviation-100-years

A century of passenger air travel

JANUARY 22, 2014  |  MAPPING

Aviation for 100 years

Kiln and the Guardian explored the 100-year history of passenger air travel, and to kick off the interactive is an interactive map that uses live flight data from FlightStats. The map shows all current flights in the air right now. Nice.

Be sure to click through all the tabs. They’re worth the watch and listen, with a combination of narration, interactive charts, and old photos.

And of course, if you like this, you’ll also enjoy Aaron Koblin’s classic Flight Patterns.

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

Institute for Health Metrics and Evaluation (IHME)

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

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

Data Visualizations

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

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

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

Tobacco Burden Visualization

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

US Health Map

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

GBD Compare

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

Mortality Visualization

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

COD Visualization

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

GBD Insight

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

GBD Heatmap

How do different health challenges rank across regions?

GBD Arrow Diagram

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

GBD Uncertainty Visualization

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

GBD Cause Patterns

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

 

healthy habits, nutrition, policy, storytelling

DH getting serious on healthy food policy

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

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

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

DH wants new Responsibility Deal measures to tackle unhealthy food promotions

18 Jan 2014 | By Ian Quinn

Health cutout

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

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

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

data saving lives, quantified self, startup

Apple raid Sano

  • Apple have started raiding software startups like Sano Intelligence (the blood monitoring patch):

The needle-less, sensor-laden transdermal patch is painless (I handled a prototype, which felt like sandpaper on the skin) and will soon be able to monitor everything you might find on a basic metabolic panel–a blood panel that measures glucose levels, kidney function, and electrolyte balance. Already, Sano’s prototype can measure glucose and potassium levels. There are enough probes on the wireless, battery-powered chip to continuously test up to a hundred different samples, and 30% to 40% of today’s blood diagnostics are compatible with the device.

 

http://9to5mac.com/2014/01/17/apple-continues-hiring-raid-on-medical-sensor-field-as-it-develops-eye-scanning-technology/

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Example of biomedical industry's work on blood sensors

Example of biomedical industry’s work on blood sensors

Apple is moving to expand its personnel working on wearable computers and medical-sensor-laden devices by hiring more scientists and specialists in the medical sensor field. Apple began work in earnest on a watch-like device late last decade, and it has worked with increasing efficiency and more dedicated resources on the project over the past couple of years. Last year, we published an extensive profile that indicated Apple has hired several scientists, engineers, and managers in the field of biomedical technologies, glucose sensors, and general fitness devices…

 

Smartening the iWatch team

Over the past couple of months, Apple has been seeking even more engineering prowess to work on products with medical sensors. Earlier this year, two notable people from the medical sensor world joined Apple to work on the team behind the iWatch’s hardware vision. Apple has hired away Nancy Dougherty from startup Sano Intelligence and Ravi Narasimhan from general medical devices firm Vital Connect. In her former job, Dougherty was in charge of hardware development. Narasimhan was the Vice President of Research and Development at his previous employer.

Unobtrusive blood reading

sano

Sano Intelligence co-founders introducing their work (image)

Dougherty’s work at Sano Intelligence is incredibly interesting in light of Apple’s work on wearable devices, and it seems likely that she will bring this expertise from Sano over to Apple. While Sano Intelligence has yet to launch their product, it has been profiled by both The New York Times and Fast Company. The latter profile shares many details about the product: it is a small, painless patch that can work on the arm and uses needle-less technologies to read and analyze a user’s blood.

The needle-less, sensor-laden transdermal patch is painless (I handled a prototype, which felt like sandpaper on the skin) and will soon be able to monitor everything you might find on a basic metabolic panel–a blood panel that measures glucose levels, kidney function, and electrolyte balance. Already, Sano’s prototype can measure glucose and potassium levels. There are enough probes on the wireless, battery-powered chip to continuously test up to a hundred different samples, and 30% to 40% of today’s blood diagnostics are compatible with the device.

With the technology for reading blood able to be integrated into a small patch, it seems plausible that Apple is working to integrate such a technology into its so-called “iWatch.” For a diabetic or any other user wanting to monitor their blood, this type of innovation would likely be considered incredible. More so if it is integrated into a mass-produced product with the Apple brand. Just like Apple popularized music players and tablets, it could take medical sensor technology and health monitoring to mainstream levels.

Earlier this week, Google entered the picture of future medical devices by announcing its development of eye contact lenses that could analyze glucose levels via a person’s tears. This technology is seemingly far from store shelves as keeping the hardware in an eye likely poses several regulatory concerns. By putting similar technology on a wrist or an arm, perhaps Apple will be able to beat Google to market with this potentially life-changing medical technology.

Screen Shot 2014-01-17 at 4.33.55 PM

While the aforementioned work by Dougherty occurred at Sano Intelligence, the fact that she “solely” developed this hardware means that her move to Apple is a remarkable poaching for the iPhone maker and a significant loss for a small, stealth startup. She notes her involvement at Sano on her LinkedIn profile (which also confirms her new job at Apple):

– Hardware Lead in a very early stage company designing a novel system to continuously monitor blood chemistry via microneedles in the interstitial fluid. Brought system from conception through development and board spins to a functioning wearable pilot device.

– Solely responsible for electrical design, testing, and bring-up as well as system integration; managing contractors for layout, assembly, and mechanical systems

– Building laboratory data collection systems and other required electrical and mechanical systems to support chemical development

Dougherty’s work at Sano Intelligence was not her first trip in the medical sensor development field. Before joining that company, she worked on “research and development for an FDA regulated Class I medical device; a Bluetooth-enabled electronic “Band-Aid” that monitors heart rate, respiration, motion, and temperature” for another digital health company, according to her publicly available resume.

Patent portfolio

Screen Shot 2014-01-17 at 5.21.07 PM

At Vital Connect, Narasimhan was a research and development-focused vice president. As Vital Connect is a large company, it is unclear how responsible Narasimhan actually was for the hardware development, but it is clear that he has expertise in managing teams responsible for biosensors. Their sensor can be worn on the skin (usually around the chest area) and is able to monitor several different pieces of data. As can be seen in the description from Vital Connect (above), their technology can measure steps, skin temperature, respiratory rate, and can even detect falls. These data points would be significant compliments to a wearable computer that is already analyzing blood data.

Besides his management role at Vital Connect, Narasimhan comes to Apple with over “40 patents granted and over 15 pending,” according to his LinkedIn profile. Many of these patents are in the medical sensor realm, and this demonstrates how his expertise could assist Apple in its work on wearable devices. Narasimhan has patents for measuring the respiratory rate of a user, and, interestingly, the measurement of a person’s body in space to tell if they have fallen. The latter technology in a mass-produced device would likely improve the quality of life for the elderly or others prone to falling.

Of course, it is not certain that the work of either Narasimhan or Dougherty will directly appear in an Apple wearable computer or other device. What this information does indicate, however, is that Apple is growing its team of medical sensor specialists by hiring some of the world’s most forward-thinking experts in seamless mobile medical technologies.

Silicon Valley

Apple is not the only company boosting its resources for utilities that can measure blood. According to sources, other major Silicon Valley companies are racing Apple to hire the world’s top experts in blood monitoring through skin.

Other biometric technologies

CEBIT SENEX

In addition to focusing on sensors that could monitor a person’s activity, motion, and blood through the skin, sources say that Apple is actively working on other biometric technologies. As we reported in 2013, Apple is actively working on embedding fingerprint scanners into Multi-Touch screens. It seems plausible that in a few years down the roadmap, Apple’s Touch ID fingerprint scanners could be integrated into the iPhone or iPad screen, not into the Home button.

Perhaps more interesting, Apple is also actively investigating iris scanning technology, according to sources. This information comes as a Samsung executive confirmed that Samsung is developing iris scanning technologies for upcoming smartphones. It is currently unknown if iris scanning to unlock a phone will arrive with the Galaxy S5 this year.

Apple is also said to be studying new ways of applying sensors such as compasses and accelerometers to improve facial recognition. These technologies could be instrumental in improving security, photography, and other existing facets of Apple’s mobile devices. It does not immediately seem intuitive to have new facial and iris recognition technologies on wearable devices, so it is unlikely that those technologies will make the cut for the future “iWatch.”

Big plans

While 2013 focused on improvements to Apple’s existing software and hardware platforms, Apple CEO Tim Cook has teased that 2014 will include even bigger plans. “We have a lot to look forward to in 2014, including some big plans that we think customers are going to love,” Cook told employees in December of 2013. These plans likely include larger-screened iPhones and iPads, updates to iOS and OS X, and sources are adamant that Apple will revamp its television strategy this year. But is an iWatch in the cards of 2014? Only time will tell. Regardless of when the product is planned for launch, it appears that Apple is stacking up its resources to create a wearable computer that is truly groundbreaking for the medical world, and that the company will not introduce it until it is ready.

healthcare, healthy habits, policy, politics, quotes & aphorisms

2014 AMA Health Priorities

Steve Hambleton
– population health
– reduce unwarranted clinical variation

Chris Baggoley
– dementia

Lesley Russell
– value-based payment

 

The five most pressing health priorities in 2014

21/01/2014

Trying to identify just five top priorities in an area as complex and ethically fraught as health care is a tough challenge, but that was the task Australian Medicine set for seven of the nation’s leading health advocates and thinkers, including AMA President Dr Steve Hambleton, the nation’s Chief Medical Officer Professor Chris Baggoley, health policy expert Dr Lesley Russell and World Medical Association Council chair Dr Mukesh Haikerwal. Here they provide their thought-provoking and insightful responses.

AMA President Dr Steve Hambleton

1.  Make population health a cross-portfolio priority for all levels of government
Population health is not just about treating illness. It’s also about keeping people well, and all portfolios (Agriculture, Defence, Education, Employment, Environment, Finance, Foreign Affairs and Trade, Health, Immigration and Border Protection, Industry, Infrastructure and Regional Development, Social Services, Treasury etc) need to do their part to fight the threat of non-communicable diseases which stem from tobacco, alcohol, over-nutrition and under- exercise.

2. Continue the investment in closing the life expectancy gap between Aboriginal and Torres Strait Islander peoples and all Australians
All governments need to keep up the investment, but not just in the health portfolio. There is stark evidence that investing in the social determinants of health and a good education, starting at birth, are major predictors of health outcomes.

3. Fix e-health and the PCEHR
We must be able to talk to each other in the same language -general practice, hospitals (public and private), public outpatients, private specialists, aged and community care. Too often the right message just does not get through. Let’s get the (e) rail gauge right and use it.

4. Reduce unwarranted clinical variation
The fastest way to save health dollars and achieve better outcomes is to (as Professor Lord Ari Darzi advised at the 2012 AMA National Conference) “close the gap between what we know and what we do”.  We know we are doing a good job and are very cost effective. If we embrace the move of learned colleges toward clinical audit and self-reflection we can make best practice even better.

5. Invest in research
The human papillomavirus vaccine will save millions of lives. Research delivered and refined the place of statins, also saving millions of lives. We need new ways of treating infections, perhaps more antibiotics or better ways to use the ones we already have.

Professor Chris Baggoley, Australian Government Chief Medical Officer

It is not easy to nominate five priority areas for action, given that there are so many deserving areas that require our ongoing attention. Of course, in my role there are a number of areas where my direct involvement is needed to help made a difference.
Understanding that this list excludes other equally deserving priority areas, my list is:
1. Antimicrobial Resistance, where concerns we are facing a post antibiotic era are widely shared across the globe. Australia is taking a leading role: we have adopted a One Health approach, a safety and quality approach (via the National Standards), and we are increasing our surveillance of resistant microbes and antimicrobial usage.

2. Emerging Infectious Diseases. The appearance of avian influenza H7N9 in China in 2013, and the Middle East Respiratory Syndrome Coronavirus in 2012-13, has redoubled the focus of all areas of the health system to prepare to manage emerging infectious diseases, and this must remain a focus for 2014.

3. Immunisation coverage. Public interest in the benefits of high levels of childhood immunisation was a particular feature of 2013, especially following the National Health Performance Authority report breaking coverage down to Medicare Local and postcode areas. Vaccine-preventable diseases should be prevented, and our attention to this aspect of health care in all areas must remain a priority.

4. Dementia. While the first three areas are part of my daily work, this is not the case for dementia. Nonetheless, the case for research into the causes and prevention of dementia is apparent to all of us.

5. Improving the nation’s mental health. Much work is underway to improve our mental health. Improved community and professional understanding and reduction in stigma will assist sufferers of mental health illness to seek help, and assist their recovery.

Dr Lesley Russell, Visiting Fellow, Australian Primary Health Care Research Institute, Australian National University

National

1. Addressing health disparities

Prime among these is the need to Close the Gap on health disparities for Indigenous Australians, but we should not forget the disparities suffered by people with mental illness, people with disabilities, the homeless, and those who are isolated, both geographically and socially. These gaps will only be closed by a broader focus on the social determinants of health through a whole-of-government approach.

2. Changing the way we pay for healthcare services

It’s time to move away from fee-for-service to a financing system that is (1) focused on value rather than volume; (2) rewards improved health outcomes and cognitive services as much as procedures; (3) encourages effective teamwork and collaboration; and (4) recognises time dedicated to education, mentoring, research, essential paperwork and communication.

3. Reworking the healthcare workforce

If we are to address the health and healthcare needs of the 21st century in a country as large and diverse as Australia, then we need an appropriate workforce and a system that enables every healthcare profession to work to full scope of practice. That means widening who can prescribe and who can work independently. The new workforce must include more Aboriginal and Community Health Workers to assist with outreach, education, care coordination and cultural sensitivity.

International

4. Antibiotic resistance

The growing threat of multiple resistance requires a major international effort involving the agriculture, food and health sectors and an increased focus on research to deliver solutions and new antibiotics.

5. Climate change

Everyone’s way of life and even national security is under threat from climate change. Developed nations like Australia must show leadership in tackling both the causes and the impacts. In the absence of government action, communities must step in to lead the way.

Professor Stephen Leeder, Professor of Public Health and Community Medicine, University of Sydney

1. National data collection and evaluation – the collection of national hospital safety and quality data is critical to monitoring the use of drugs and controlling the rise of drug-resistant infections. Information is also needed to track progress in preventive health, such as in addressing obesity. Repeated surveys, done by the same people using the same survey instruments, are needed to judge our progress.

2. We need to tell the story of what we are achieving in health care for the tens of billions we invest in it. The community who pays deserves to hear. Health Ministers need to enunciate what the goal of providing health care is, backed by stories that illustrate what is achieved every day in caring for people. These stories are needed to keep compassion alive in our democracy.  “Look where my Medicare tax dollar goes!” would be a great thing to boast about, and would enable ordinary taxpayers to see that their tax contributes to something of immense social value.

3. Fixing IT. We are 20 years behind best practice. We can see what it looks like in the US. It requires a huge investment, but the pay-off in quality is immense.

Martin Laverty, Chief Executive Officer, Catholic Health Australia

1. Causes of ill health need to constantly inform both health policy and practice. Two-thirds of Australians are overweight, 16 per cent of Australians smoke, and 13 per cent drink at levels of risk. Implementing Senate recommendations on social determinants of health would revive efforts to prevent Australians, particularly the most disadvantaged, from suffering avoidable chronic illness.

2. Coordination of health services around a person’s unique needs must become more of a priority, to improve patient outcomes and reduce waisted expenditure. Ideally, any person with an ongoing health complaint would have a health plan worked out and appropriately managed to focus on right treatment in the right place, ongoing medication management, avoidance of duplicated service, and prevention of further disease.

3. Health workforce constraints and industrial barriers still haven’t been resolved to ensure Australia will have enough medical, nursing, and allied health staff to meet Australia’s growing and ageing population. Role redesign of who does what in the health system remains essential, but as a nation we’re no closer to being able to solve workforce constraints because of entrenched industrial perspectives.

4. Consumer choice underpins the new National Disability Insurance Scheme, and is being introduced into home care for the aged. Better choice in health and aged care also needs attention, so that competition and contestability can drive improvements in financial and clinical outcomes.

5. End of life care needs the entire community’s attention. Health professionals and health consumers need to give new consideration to talking about, determining, and then implementing future care plans. Pastoral care for those in the final stages of life, indeed for any person dealing with significant illness, needs elevation as a priority for health and aged care providers.

Dr Mukesh Haikerwal, Chair of Council, World Medical Association, former AMA President

With a new federal administration in place, a fiscal Armageddon heralded and the health settings for Australia being less favourable, the usual troupe of kite-fliers have been showing their wares in the ‘silly season’. What I think we need is to secure the fundamentals and enhance and support sensible collaborative work practices.

1. Support more care out of hospital – don’t penalise quality holistic care in general practice.

Embed the notion of general practice as the bedrock, not only of primary health care and all out of hospital care, but also for health care delivery across the nation. The costs of the same care out of hospital, when appropriate, are a fraction of the cost in hospital.

2. Enhance hospitals and support the care provided there, and stop perverse penalties.

Support the existing hospital infrastructure that is struggling with the burden of increased demand and expectation from patients and from governments, which absurdly see them penalised for trying their hardest to cope with this. There needs to be a move from blame to re-setting costs and targets based on realistic care need evaluations, allowing for inevitable variation.

3. Embolden and formalise clinical leadership in health in a meaningful way.

Use clinical Senates – groups of cognisant, focussed individuals suggesting and supporting innovation in health care delivery. Enhance their work by trialling and evaluating changing concepts before whole-of-system adjustments, so that unforeseen consequences are outed and adjusted for in real situations with real doctors treating real patients.

4. Use e-health and telehealth logically in clinically safe and acceptable forms over and above the PCEHR, especially secure messaging delivery and web-based videoconferencing.  

Use innovative technologies in health (e-health and telemedicine) for clinical purposes, with clinical needs and drivers at the forefront. We do have potential technology to support and enhance (but not replace) trusted, proven good clinical methods. This is over and above, but could include, the PCEHR. Secure email to connect information is the key element.

5. Innovate with translational research in real clinical situations, proving concepts before rolling them out.

In care settings, sequential work across disciplines and health care establishments, with clinical participants nutting out how to best to innovate. Use just one set of agreed best practice guidelines that promote translational research that have been promulgated to, and agreed by, relevant medical groups. Make sure the economics and medicine are understood: it may cost more to implement in the beginning, but it will save on costs down the track.

Dr Brian Morton, Chair, AMA Council of General Practice

1. End of life care – There is an expectation that modern medical technology and care will extend life, but at what cost to the quality of life? The preparation of an Advanced Care Directive when competent will bridge this gap.

2. Lifestyle health issues – The genesis of many health issues are related to poor lifestyle choices which then require medical solutions. We need brave governments to implement public health interventions to de-medicalise preventive management.

3. Obesity – a whole-of-community response is required to manage the obesity “epidemic”, including responsible marketing and labelling of foods, appropriate food helping sizes, ready access to exercise programs, dietetic advice and legislative recognition that obesity is a risk factor for multiple chronic diseases.

4. Prostate cancer – A rational evidence-based and consensus approach is needed regarding screening and management.

5. Alcohol – A multifactorial societal approach is fundamental to alcohol management.