Three Market-Based Strategies to Prevent Chronic Illness

In prior posts, I’ve asserted that both the individual and society share responsibilities for the prevention of chronic illness (see Individual v Community Responsibility for Health, KP 101: our philanthropy, and A Tour of Trees, among others).  I’ve also described the gap that often exists between what an individual knows he/she should do and what is actually done (The Knowing Doing Gap).

the vitality institute logo

In this post, I’ll combine those themes in the context of the Vitality Institute, a non-profit NGO launched last year seeking the creation of public-private partnerships that promote health (rather than healthcare) and prevent illness (rather than measures to treat it). Instead of arguing my point using the traditional science of public health, however, I’ll use the science of market-based economics, believing the latter more useful when understanding and influencing human behavior. Each example I provide is scalable, from a small to large company or community.

First, Create Supply… of healthy food choices, fitness opportunities, and preventive services. I know, I know. Traditional econ says demand precedes supply. But I believe the opposite is true when creating healthy human behavior, because 2 million years of evolution has hard-wired us to prefer simple sugars, dietary fat and animal protein, and the conservation of calories.

atlanta beltline

Public Supply – provide multiple points of entry to multiple green spaces (see Atlanta Beltline); set aside land for future public parks (see Trust for Public Land or Georgia Conservancy); provide subsidies for communities to nurture Green Markets and Buy Local campaigns; correct the imbalance of supply of unprocessed ingredients (i.e., grocery stores) and processed food (i.e., fast food restaurants) in low socioeconomic communities; create bike and pedestrian space (see TED Talk of Janet Sadik-Kahn, NYC DOT under Mayor Bloomberg, Atlanta Beltline); spread Power Up for 30 in our public schools (see GA Shape); and embrace certain provisions of the 2010 ACA (preventive care has no co-pay).

nyc bike and pedestrian lanes

Private Supply – corporate subsidies of gym memberships or Zumba classes; provision of showers and locker-rooms in the building; change the contents of vending machines; create non-smoking campuses; arrange for healthy food trucks during lunch; build on-site health clinics;  sponsor nutrition classes and flu-vaccine fairs.

Second, Create Demand… for those good choices. Wouldn’t it be cool if we changed our worship of beautiful appearance to worship of healthy behavior?  I’m told some women do indeed prefer salad-eating, gym-going men.

Public Demand – insist grocery stores provide the provenance of produce; create compelling advertising and marketing campaigns that express the benefits to individuals of buying local (think of the successful Made in the USA campaign); revise the school lunch program to provide healthier choices, then make those choices more appetizing to kids (yes, it’s been done successfully);

buy local

Private Demand – sponsor participation in fitness or philanthropic programs like the annual KP Corporate Run Walk, AHA Heart Walk and Komen for the Cure; sponsor corporate “challenges” like the TSPMG 21-day Vegan Challenge, or one of the biggest loser competitions;

Lastly, Facilitate Consumption … of those good choices.  Seldom do we behave in healthy ways merely because those choices are available, coupled with the knowledge those choices are “good for us”. Our belief systems, borne from our past experiences, dictate our behavior much more than “perceived choice” or “possession of knowledge about the potential benefits of the better choice”. Those better choices must align with our individual, immediate feelings and benefit our individual, long-term interests, whatever they are.

weight of the nation

Public Consumption – make the public green-space safe at all hours of the day; make city-bike programs easy to use and affordable; ensure the safety of pedestrians and cyclists on city streets; halt the subsidization of high-fructose corn syrup (watch Weight of the Nation), and perhaps begin a modest subsidization of fresh produce; create funding for infrastructure that reduces commuting time (such as the 2012 Georgia Transportation Referendum), thus increasing discretionary time for fitness or food preparation.

Private Consumption – employers can provide podometers and incentives to employees to “consume” fitness or proven preventive screenings; healthcare providers (physicians, hospitals and delivery systems) should prove that a specific level of in-year employee consumption of their employee’s good choices will guarantee for the company an equally specific decrease in healthcare costs or increase in profitability.

jawbone

In my market-based approach, I’ve deliberately ignored the important area of Reducing Risky Behavior. Institutions such as the CDC, States Department of Public Health, National Transportation Safety Board, NIOSH and OSHA (among many others), have that covered.  But one could summarize all as “abstain from tobacco, avoid excessive alcohol, use condoms, and wear seatbelts”, roughly in that order).

Kaiser Permanente has been a national and local leader in creating and enhancing such public-private partnerships for the betterment of America’s health. Just here in Atlanta, we’ve sponsored the Green Market at Piedmont Park, the Annual Corporate Run-Walk, the Eastside Trail of the Atlanta Beltline, the HBO documentary Weight of the Nation, the 21-day Vegan Challenge, gym memberships for employees, and so on.  More such partnerships and infrastructure are needed in Atlanta and across the US to create the supply, demand and consumption of healthy behavior, if we are to reverse America’s raging epidemic of chronic diseases.

My Italian Lesson

santa maria la scala at the sea June 2013

volcanic rock streets

There’s no way you’d call this a road … more like an alley.  The homes and family businesses lining the “Via” are made of 18×24 inch blocks of volcanic rock, cut and placed by hand 300 years ago, forming a canyon for fast moving pedestrians, bicycles, scooters and cars … with no more than 2 inches to spare all around.  I manually retract my side-view mirror at 30 km/hr to avoid collision with the on-coming Fiat 500 (Cinquecento, pronounced “Chin-kwa-chen-toe”) around a blind corner, and neither of us bats an eye.

These two weeks in Sicily have provided an opportunity to reflect upon what cultural successes of this 5,000 year civilization might apply to our 160 year old city and it’s planning as this century progresses.  I know … Sicily and Georgia are vastly different in economic, social and political context.  But that just makes the question more interesting, and perhaps more relevant.  Can we can sift the chaff (less consequential structural differences) from the grain (a thematic path to a healthier way of life).

santa tecla restaurant June 2013

No space is wasted, which leads to (1) creatively simple architectural and civic design, and (2) a thing is exactly the size it needs to be and no more.  Communal space outdoors serves as the place to stretch and expand with family and community, more than making up for the smaller space indoors. Relevance to Atlanta: at this year’s Annual Landmark Luncheon for the Piedmont Park Conservancy, Atlanta-based designer and TV personality Vern Yip challenged us to create smaller, multi-use interior living spaces, thus less carbon footprint, closer family encounters, more affordably.  Well, and a need for better manners.

built to last Sicily 2013

Most things are built to last, and usually do.  Reuse and repair are bigger than recycle here.  Smaller homes and apartments are made of concrete and brick-blocks, requiring less energy to heat and cool, and ceramic tile easier to clean, rather than large boxes of wood, carpet and synthetics that leak energy and retain allergens.  Relevance to Atlanta: when available and affordable, buy things designed to last a long time with episodic repair or refresh. Over time, manufacturers and builders will change to meet that demand.

mediterranean diet Sicily 2013

Health is part of the day, rather than an add-on if time permits. Eighty percent of the meals consumed in this community are freshly prepared in the family kitchen, from farm to table ingredients.  The other twenty percent are purchased from family-run, neighborhood businesses (bakeries, Italian ice [granite], coffee, and yes, pizzerias).  The tomatoes here actually have flavor. The fruit is freshly picked when nearly ripe, sold out of the back of tiny trucks, locally.  In my observations, most locals walk 6-9K steps per day here. Relevance to Atlanta: lets buy local Georgia produce, return to the kitchen, getting the whole family involved in the meal.  Organizations such as Trees Atlanta, Park Pride, Georgia Conservancy, and Piedmont Park Conservancy deserve our financial and physical support.  Zoning and neighborhood planning boards should approve multi-use projects that promote lasting design and constructuion principals, and walking over other transportation (pedestrian piazzas, green walkways, sidewalks and bike paths).

mtn trail connecting acireale and santa maria la scalla

The people of Sicily had to adapt to many cultural, economic and political changes through the centuries (Greeks, Romans, Phoenicians, and finally the Italians all ruled here), and made it through just fine.  We can adapt to changes in our day to day lifestyle that will strengthen the generations yet to come, by adopting some of what our Sicilian brethren have modeled.

pattie by the sea Sicily 2013

Gardens Among Us

botanical gardens, chihuly fountain HD, May 2013

botanical gardens, lady by the pond topiary HD, May 2013

Year-round flowers are part of life in Atlanta, so it may not be part of your routine to visit the Atlanta Botanical Gardens during the year. I’ve got gardenias, jasmine, peonies, cone flowers and floribunda roses blooming in my backyard, yet we were eager to visit the new topiary exhibit at the Botanical Gardens this past weekend.

We strolled through our longtime favorites too … the edible garden, walkways with canopy of crepe myrtles overhead, and the frog pond.

botanical gardens, splash of color HD, May 2013

The orchid display dazzled once again – brilliant colors wrapping a winding walkway through a man-made rainforest. The diversity of this one genus is humbling, effortlessly reminding us of the complexity that nature can create.

botanical gardens, orchids #3 HD, May 2013

I particularly liked seeing all age groups enjoying the Gardens. Kids were balancing upon the perimeter walls of the fountains, hiding from parents around the next bend along the trail, and running through the elevated walkway to get the best look of the unicorn.

botanical gardens, unicorn topiary HD, May 2013

Atlanta has many outdoor treasures to choose from, but none greater than our Botanical Gardens. Whether you visit limited engagements like the topiary, or view the annual Christmas Light display in December, or tour the edible garden during its height in July, don’t let a season go by without visiting.

A Tour of Trees

beltline eastside trail with skyline, ca 2012

I’ve walked the Eastside Trail of the Atlanta Beltline several times this year. This is the first section of the Beltline to open, representing 2.25 miles of the entire 22 mile loop. The multipurpose trail is filled with walkers, runners, cyclists, and kids, all enjoying the outdoor green space. The trail and resultant rejuvenation of adjacent neighborhoods is substantially adding to Atlanta’s distinctive character.

beltline eastside trail, ca 2012A wonderful partnership has blossomed between The Beltline and Trees Atlanta, the latter a thriving non-profit dedicated toward preserving, restoring and expanding Atlanta’s urban forest. The best known example of that partnership is The Beltline Arboretum. Trees Atlanta has nearly completed the Urban Forest Corridor along the Eastside Trail, planting thousands of trees and meadow grasses during the last year, a result of the donations and sweat of hundreds of volunteers and a handful of staff.

Kaiser Permanente has been delighted to sponsor the Arboretum’s Docent program, a 60-90 minute walking tour of the Eastside Trail, when one can enjoy the many tree species planted along the trail, learn about the history of the surrounding neighborhoods, and imagine the future of the Beltline. Docent Bill did a great job on the tour I attended.

bill the arboretum docent, May 2013

If you want to sample what the Beltline has to offer, and envision the future of your city, I encourage you to attend an Arboretum tour.  You’ll be glad you did.

atlanta beltline arboretum logo

Party by the Pond

trees atlanta logoTrees Atlanta held its annual grand fundraiser last night, entitled “Party by the Pond“.  We had a wonderful turn-out, with over 200 patrons enjoying conversations about conservation, tributes to trees, and an active auction to benefit The Cause. On behalf of the Board, we express a heartfelt “thank you” to those who attended.

two women planting a treeThe staff at Trees Atlanta begins and ends each day preserving and improving Atlanta’s urban forest.  They plant thousands of trees each year, then care for them in the critical early years after planting.  Our thousands of volunteers expend blood, sweat and tears restoring the life-giving, beautiful green canopy to neighborhoods around the city.

 

crowd of TA volunteersThe staff, volunteers and donors of Trees Atlanta have earned their reputation around town as humble environmental servants, eager to collaborate with other environmentally focused organizations.  While Trees Atlanta has been the recipient of much recognition for its hard work (most recently an award from EarthShare Georgia 2013), it is happiest for others to have the limelight, knowing that true fulfillment comes from reducing city heat, improving habit for birds, butterflies and bees, and providing natural beauty for residents.

another planting by trees atlantaFollowing a lot of hard work from Connie Veates and Greg Levine (co-Executive Directors of Trees Atlanta), and Marcia Bansley before them, Trees Atlanta is enjoying its greatest period of good-will and momentum in its history.  Each of you who has volunteered and/or donated money to plant a tree or reclaim an urban woodland owns a piece of that growing good-will and success.  We intend to maintain your trust in us by delivering even greater results in the years to come.

In June Dr. Schreiner assumes the role of President, Board of Directors, taking over from Mr. Ed Dobbs, who, along with others, enabled Trees Atlanta to achieve so very much during the last decade.

Is the Math of Environmental Stewardship Addition, Subtraction, or Multiplication?

Our intuition tells us that individual businesses in the same industry MUST compete with one other for finite resources (i.e., each business competing for a fixed amount of revenue from a limited number of customers).  Indeed, as I speak to environmentally conscious volunteers and leaders around Atlanta, I hear subtle talk of “staying out of each other’s way”, or “not encroaching upon each other’s mission”, or “competing for donations from the same benefactors”.

tug of war

But what if our intuition was wrong in this regard?  As I wrote in a post earlier this week (“Intuition v EBM”), our intuition can mislead, particularly in complex matters like human behavior.  We must consider what The Science says regarding cooperation v competition.  Even better, what if, by collaborating with one another, the dollars donated (whatever they are) were to go further – do more total good – when similar non-profits collaborate on mutually interesting environmental programs?

john nash

John Nash is better known as a result of the 2001 film A Beautiful Mind than his 1994 Nobel Prize in Economics, but he was one of the first scientists to mathematically theorize how cooperation among competitors can lead to greater wealth for all.   But if that’s too esoteric for you, think how geographically aggregating car dealerships results in MORE cars sold overall than if each dealership was geographically disparate (true).  Think how having MORE goods to sell (Super-Target) leads to more sales for each manufacturer on the shelf per customer visit (true). Think how concurrent appeals at Christmastime from The Salvation Army (silver bells), The Marine Corps (Toys for Tots), and The Atlanta Food Bank (conspicuous donation bins at work) might subconsciously collaborate to increase our total year-end philanthropy (my belief).

toys for tots, three marines

But the real goal of course is to create multiplication, rather than addition, of environmental benefit, as environmentally focused non-profits in Atlanta collaborate to make the dollars donated to all organizations do more good for all Georgians.

meaning of multiplication

A nice example of such multiplicative collaboration here in Atlanta is the joint work between Trees Atlanta and the Atlanta Beltline, both in terms of (1) populating the Eastside Trail with hundreds of trees and thousands of grasses, and also (2) in the wonderfully successful co-branded program known as The Beltline Arboretum.  The Beltline Docent program would not exist (funded by Kaiser Permanente by the way) in the absence of such collaboration.

beltline arboretum logo

So here’s my point:  I challenge all of us (Trees Atlanta, Beltline, GA Conservancy, Park Pride, Chattahoochee Riverkeepers, Piedmont Park Conservancy, and so on) to multiply each other’s accomplishments, through more collaboration, rather than covert competition.

russell crowe as john nash

Selling Environmental Stewardship

Whether you wish to admit it or not, we are all of us, salesmen and saleswomen.

salesman 1950s

When I’m at the bedside of a patient, I’m selling my diagnosis or treatment recommendations, based upon my demonstrated deep knowledge of the patient and her problem, my expertise and experience, the level of my authentic empathy, among many other important intangibles.  Our elected officials sell their point of view of The Societal Problem To Be Solved with their policy and legislative agenda, and/or their proposed funding mechanism.  Researchers sell their results as novel and relevant, ideally to generate believers who will then change their own or society’s behavior (think climate change, HBO’s Weight of the Nation, or the latest drug, diet or robotic-surgery).   As highly individualistic Americans (see my post from Friday, March 22), we have the freedom to accept or reject each sales pitch.

doctor + patient hand at bedside

Similarly, we enthusiasts of environmental stewardship must sell the relevance of our work to an American public understandably preoccupied by the war against al-Qaeda, The Fiscal Cliff, The Great Recession, Government Gridlock and the absurd cost of healthcare.  Moreover, what of the brutal daily calendar of American families, juggling school, homework, activities, and sleep?   Given such an intense competition for attention, money, and time, our sales pitch must sing.  So it would be useful to know how framing the sales pitch can help or hurt its effectiveness when presented to potential benefactors and volunteers.

shankar vedantam ca 2010

Shankar Vedantam, a science correspondent for NPR and author of The Hidden Brain, reported this past week on a Stanford study which showed that thinking about the greater good undermines mental and physical performance on tasks, whereas thinking about individual freedom and choice improved mental and physical performance on those same tasks.  This phenomenon was particularly true when contemplating environmental policy.  When framed in the language of individual liberty or individual benefit, the test subjects felt more drawn to environmental philanthropy.  When framed in the language of the common good or control, subjects were much less likely to behave favorably toward the protection of land or natural resources.  This phenomenon was strongest in European Americans, and nearly undetectable in Asian Americans.  The conclusion – Americans in general, and those of European descent in particular, appear hard-wired (through culture or genetics) to compete with The Common Good.  I wrote about this in “The Tragedy of the Commons, Revisited.”

irish pasture with grazing cows

So how might emphasis upon “greater individual freedoms” look, when we pitch participation in environmental stewardship?

Rather than, “Think of all the people who will be able to use this new park!  Your grandchildren will love it!  It will enhance the value of homes and businesses in your neighborhood.  And we’ll control it’s use and protect the park forever.”

More like, “Think of all the use you’ll get out of this new park!  Your grandchildren will entertain themselves!  It will enhance the value of your home prior to your retirement.  And no one will ever take away the park from you.”

piedmont park with beach volleyball and midtown in background

Whether you prefer the term “selling” or “influencing”, we share a moral imperative to successfully prosecute the Environmental Agenda.  Let’s become better at it, by using the emerging knowledge of the hidden brain.

Individual v Community Responsibility for Health

constitutional convention 1787

American culture is a lot about individualism.  From our country’s founding documents protecting personal liberty and property above all else, to our literary heroes (lonely cowboys, heroic soldiers, brilliant inventors, and even business tycoons [Steve Jobs]), to our favorite cinematic protagonists facing the bad-guys alone (James Bond, Indiana Jones, Luke Skywalker), we love celebrating the rights, achievement, and spirit of singular individuals.  Oh, and the more curmudgeonly, iconoclastic, and independent, the better.

 

jordan winning shotIt even shows up on the NFL field of play – an offensive coordinator can call the perfect play, the front line can block the pass rush, a quarterback can throw the perfect pass, but only One, the wide receiver, is permitted to dance in the end-zone.   I recall more of Michael Jordan’s iconic game-winners, than I do the first 47 minutes of team play that enabled him (or anyone) to win it.

 

stephen colbert, thumbs up

Ironically, while the Protection of Individual Rights is more often attributed to one political party, it’s the other party who more often protects and advances those rights (Brown v Board of Education, Civil Rights Bill, Roe v Wade, Same-Sex Marriage, etc).   Queue Stephen Colbert.  But, I digress.

 

So I totally understand when I hear that personal health is the primary responsibility of the individual.  Certainly, making better food choices, eating less quantity, exercising more, not using tobacco products are things each individual should do, and may do.  But is there a role for the community to make those behaviors more can do?

eastside trail ca Fall 2011For example, do we as communities provide enough well-kept green-space, enough public safety (pistol-carrying runners notwithstanding), enough sidewalks, public bike-rentals and planned development?  When will we halt the subsidization of high-fructose corn syrup in favor of a level playing field for fruits and vegetables?   When will we demand from restaurants they include calories and fat content on each menu (not necessarily mandate it, rather demand it, as consumers)?   Oh, and ketchup was never a vegetable.

 

beltline arboretum artist sketchYes, all of us, including me, must behave more responsibly as an individual when it comes to our personal health (eat less, move more, get our vaccines and cancer screening exams).  AND at the same time, we collectively can empower and enable individuals to behave more responsibly by providing more of a healthful infrastructure in our communities.  Join Park Pride, Trees Atlanta, Georgia Conservancy, Piedmont Park Conservancy, Atlanta Beltline, or any other noble organization trying to advance individual freedoms by providing and protecting collective-use environmental infrastructure.

 

400-Year-Old City Trees

He loved her madly. She loved him too. But sometimes love is not enough. She couldn’t bear to leave her beloved Granada to join him in Sevilla. Yeah, he was the provincial king. Yeah, he just renovated and expanded the 300 year-old palace (Alcazar). But the trees of Granada … ah the city trees … particularly the sweet air of spring when the fruit blossoms opened. Sure, this was a new age … the dawn of The Renaissance actually. Modern times indeed … It was the 16th century after all. But how could she leave the trees. So he knew what to do.

20130316-131957.jpg

Anyway, that is how the locals tell the story of how the entire city of Sevilla (Seville), Espana (Spain) came to be enveloped in Orange Trees 400 years ago. The king spent a fortune planting thousands of orange trees (and birch, magnolia, …), thus his fiance’ followed. To this day, the 15,000 orange trees lining each street and populating the roundabouts and parks in Sevilla are not just part of the history and folklore, not just providing badly needed shade in the 105 F summer days, but woven into the city’s soul.

I see this as Atlanta’s destiny.

Consider the similarities between the two cities. Both are hot in the summer, and likely to get hotter. Both have an urban forest beloved by the people for the shade and aesthetics provided. The people of Sevilla made a decision centuries ago to preserve the largest trees for the benefit of coming generations. My daughter sure enjoys them (she lives there).

DSC_0109

Please join Trees Atlanta in our mission to preserve the oldest oaks, magnolias, elm and hickory. Your grandkids will be glad you did.

Protect Your Georgia

The Georgia Conservancy was founded in the 1960’s to protect our state’s land, water and air.   We have five pillars upon which we fulfill that mission: (1) advocacy (for example, we successfully fought to preserve the natural beauty of Sweetwater Creek and Cumberland Island), (2) land conservation (for example, we facilitated the setting aside of 3200 acres in Georgia last year for natural habitat and the outdoor enjoyment of generations to come), (3) sustainable growth (for example, we help design new communities and site new schools), (4) protecting Georgia’s 100 miles of coastline (for example, we work with many organizations and individuals to protect marshes and barrier islands from pollution and excessive development), and most importantly (5) membership (we can’t do it without YOU!).

Our President, Mr. Pierre Howard, effectively leads our efforts by seeking common ground among all interested parties.  Pierre uses his years of hard-earned wisdom and success in Georgia’s State Capital (as former Lt. Governor) to honestly and transparently navigate the intersection of business, politics / policy, and the environment.  Solutions at that intersection demand an authentic leader, seeking collaborative solutions.

The Georgia Conservancy makes it easy for you to get involved – become a supporter and/or volunteer today (http://georgiaconservancy.org/).