Technology

Behavior change to improve health

The state of health in America

The state of health in America is in crisis.  Obesity rates, diabetes rates, depression – all one needs to do is turn on the TV or surf the web to understand that we’re on a razor’s edge.  It can seem overwhelming because of the sheer scale of the problem.  What are the most fundamental problems that need to be solved to solve the state of health in America?  Over the past few months, I’ve been reading a lot and taking time here and there to think about this question and what some possible answers might be.  So far, it seems like the simplest areas would be the most impactful.  I propose therefore that four fundamental hurdles that need to be overcome to improve the state of health in America are as follows:

• People’s ability/motivation to make good decisions on nutrition
• People’s ability/motivation to be active and to build strength
• People’s ability/motivation to reduce destructive behaviors (e.g. smoking, drinking excessively)
• People’s ability to access primary care via someone with whom they have a relationship and who knows them well (the ideal vision for this is based largely in the concept of the medical home)

If you agree that these four are significant contributors to the poor state of health in America, then we can ask ourselves the following question:  How do we get people to *want* to make the behavior change around the items above?  Today I will focus on the first item (I’ll cover the others in later posts)

Why don’t people make good nutritional decisions? Like any complex social issue, there is no one simple answer.  There are multiple contributing factors, but in my opinion two significant contributors are that we are addicted to convenience and our educational/family system has done a horrible job at educating people how to properly feed their body.

1. The extinction of the family dinner time It used to be that most families sat down together for at least one home cooked meal every day.  Food wasn’t about convenience, but about togetherness and family.  Over time, single-parent households became much more common, working hours got longer, people’s schedules got busier, and home cooked dinners became a luxury.  “Food on the run” became the norm.   Businesses in the US are incredibly smart when it comes to optimizing around what the customer wants.  When it became evident that Americans by and large placed higher value in food that could be quickly prepared, in large quantities for the least amount of cash – businesses took notice and the food industry simply gave us what we wanted.  The result is an incredible selection of foods that are nutritional ‘question marks’.
2. Lack of education/food awareness When one creates a home-cooked meal from scratch, it’s evident what the ingredients are.  When one lets someone else essentially cook for them, then the ingredients become obfuscated.  When one compares the marketing and advertising dollars that are spent to encourage us to consume mass produced, ‘engineered foods’ against the amount of time, money and effort into educating the population how to cook for themselves in a way that will meet their body’s nutritional needs, is the state of health in America really a surprise?  The lack of education around how easy it is to cook nutritious meals at home, combined with misguided attempts to vilify fat (or carbs or sugar, or dairy, or eggs, or… well, you get the idea), added to the abundance of quick, easy, readymade meals is a recipe for disaster.  The result is a society that has become seriously uneducated about how much and what types of nutrition our bodies really need and how to meet those needs.

So back to the question:  how do we increase people’s motivation to make good decisions about nutrition?  One answer is through a combination of focused education and focused reward.  “Education” would focus on ensuring that people know what is a ‘good’ nutrition decision and what is a ‘bad’ nutrition decision.  “Reward” would measure the results of those good decisions and would literally reward improvement on those metrics.  One way of doing this is via value based benefit programs where consumers get cash for completing certain activities and meeting certain goals.

The good news is that there is no shortage of educational content on which foods are nutritious and which are not.  The better news is that employers and health plans are demonstrating the willingness to implement value-based benefit plans and wellness plans that provide real incentive to behavior change.

What are your thoughts on how to encourage behavior change?

© 2010 medullan | blog.