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.

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