The anatomy of health changes

We are on the verge of a major change in the health system both here in New Zealand and in the wider world. We face to sad paradox – while an estimated 870 million people are under nourished, over 1.4 billion are over weight. Both phenomena create consequent health problems, causing human misery and depleting our resources. Fortunately an increasing number of us are gaining more nuanced appreciation of this problem. It is clear that the problem of excessive weight is as much about the quality of food eaten, as its quantity.

The industrialisation of the globe has generated huge benefits for us and supported the development of modern health services. But consequent changes in our diet and lifestyle are eroding and even negating these benefits. We eat too much energy dense and nutrient poor, over-processed food.

A paradigm shift

It is helpful to understand the forces at work through the concept of the paradigm shift. Thomas Kuhn coined the term in his book The Structure of Scientific Revolutions in 1962. He argued that rather than evolving steadily, science progresses through periods of revolution and orthodoxy. After the revolution, a new scientific orthodoxy is established, but over time becomes resistant to change and new influences. The next revolution will only happen when the sheer quantity of new information and thinking displaces the old.

paradigm shift nutritional food

The dynamics of a paradigm change

We are approaching this point now. Industrialisation has provided us with convenience foods that are highly processed and nutrient poor – much of the nutrition in food simply doesn’t survive through processing and distribution systems. The health system has largely accommodated this situation and accepted it as “normal”. In Western economies, the majority of health resources go into dealing with the consequences of poor nutrition (this is still contentious, but it is not the focus of this article to argue this point). And incidentally, many health professionals and health service and supply industries benefit financially while the situation persists. Another force that supports this paradigm is the food industry that produces this “fake food”. Based on ineffectual public policy, it also appears that the majority of policy makers are embedded in this paradigm.

The new paradigm is based on the understanding that eating nutrient rich food that is minimally processed supports our health. One of the main forces supporting this change is the Internet. The exchange of scientific and clinical information about nutrition is intensifying exponentially and is available to an ever-increasing group of health literate users. These people can find supportive health professionals in their communities and online. Some cafés and restaurants are following the trend and providing nutritious and tasty food.

The broader sustainability movement supports this new paradigm. Approximately 26% of the New Zealand population fits the Lifestyles of Health and Sustainability (LOHAS) market demographic. The Living LOHAS report describes the demographic:

LOHAS aligned consumers look behind products and services to an Hippocratic oath assessing whether they should buy a given product or service. They probe for alignment of organisational intent. Authenticity of the offer is mandatory and the company is mandatory. LOHAS consumers want to know “where does it come?”, “how is it made?”, “what is it packaged in?” and “what will happen when I dispose of it?”.

Imagine the health we will enjoy when we embed this new thinking in health systems adding to the known benefits of industrial age healthcare – hygiene, infection control, appropriate surgery and physical trauma treatments for example.

The ethical challenge

The story of the two stonecutters illustrates the ethical paradox many health professionals face.

A man once encountered two stonecutters and asked the first “What are you doing?” He replied, “cutting a stone”. When the second stonecutter was asked, he replied “I’m building a cathedral”.

We have plenty of very competent and dedicated health professionals who are skilfully and diligently cutting their own stones. Its not so easy to find those who can find cognitive space for both their specialist skills and an overview of the system’s effectiveness. While practising ethically in their own professional space, they participate in a system that inflicts damage on society and an increasing burden on taxpayers. Where are the cathedral builders?

Engaging to change

For those of us who wish to promote a health revolution, engagement is a key to change. In the discursive battle that accompanies any significant paradigm change, it is easy for the antagonists to dichotomise, but this often leads to entrenched and reactionary views. Niki Harré’s excellent book Psychology for a Better World, suggests that people need to be engaged emotionally to further any worthwhile cause. She also emphasises the need for the need for positive example – leading by example.

I changed my diet for the better on being diagnosed as pre-diabetic. These changes helped me to lose 13 kgs in four months. The health benefits for me have been so dramatic that I need little motivation to stay on this path. In my journey I have found good friends with good advice, a rich resource on the Internet and supportive health professionals.

My work provides opportunities to work with health professionals and community health activists creating a rich matrix of people wanting change. We need to seek out those health professionals who can see the bigger picture and work together for change. Thus two avenues of change are created, a grass roots led change and , sooner or later, policy change.

What do you think?

Useful links

Here are some of the materials that I have found useful. Gareth Morgan is a New Zealand economist who puts his massive intellect to work on various social issues. His book Appetite for Destruction elaborates on the dangers of “fake food”. He also provides an economist’s perspective on how a government might profit from a radical overhaul of health funding, including taxing “fake food”.

Several competent physicians provide mountains of information on health and nutrition:

The Green Med Info website includes a huge resource of research papers on health and nutrition.

 

 

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Mobilizing the Response | The Regeneration Roadmap

There are a lot of wise people advocating pathways to sustainability. The Regeneration Roadmap is a project of Globescan and SustainAbility and aims to promote engagement and collaboration between NGOs promoting sustainability, and the private sector.

This video, from the Regeneration Roadmap website, features an impressive array of sustainability champions, including David Suzuki, Gro Harlem Brundtland and Rajendra Pachauri advocating for change.

Mobilizing the Response | The Regeneration Roadmap.

Engagement and the Regeneration Roadmap

Engagement processes are at the leading edge of sustainability. The Regeneration Roadmap is an initiative of Globescan and SustainAbility aiming to achieve sustainable development within the next generation. Their focus is on the private sector to drive a lot of change.  This video features global thought leaders articulating the road to sustainability. As you watch, notice how pivotal engagement is a agency for change.

Mobilizing the Response from The Regeneration Roadmap on Vimeo.

Gro Harlem Brundtland, a past Norwegian Prime Minister and Director General of the World Health Organisation. She is currently a Special Envoy on Climate Change for the United Nations. She places engagement at the heart of change.

Personal engagement, personal commitment and building confidence with other people and other nations is the only way to move forward.

The video reinforces the need to generate positive discourse around sustainability, articulate a vision of a sustainable planet and create a culture to embed sustainability as a way of life.

For more videos by these gifted thinkers go to the Regeneration Roadmap website.

Moral leadership – the foundation of prosperity

The renowned economist Jeffrey Sachs pinpointed the foundations of a prosperous economy in a recent article. He states: [1]

His post celebrated the life of the late Václav Havel, the Czech playright, who spoke out against the communist regime. His determination to speak out against the suppression of human rights by the communist government saw him imprisoned on multiple occasions. On the collapse of the communist regime, the new Federal Assembly unanimously voted him President of Czechoslovakia.

What is the connection with engagement? Among Václav Havel’s writings is the essay The Power of the Powerless where he decries those societies who force their citizens to “live within a lie”. He was a strong advocate for people having a voice. Moral leadership is about seeking the best interests of the community rather than pursuing a personal agenda. Being imprisoned for speaking out for others is strong evidence of moral leadership.

Corporations have the potential to be as oppressive as a corrupt state if they choose to pursue only their self-interest – and there is plenty of evidence of this (for example, the Enron story). Fortunately, there is a change of consciousness happening as corporates are wising up to the reality of a hot, flat and crowded world and the folly of a myopic short-term focus on profit. Whatever the motive, be it a crucible-forged awakening, altruism or enlightened self-interest, forward thinking corporates are manifesting moral leadership.

Sustainability is inextricably linked to concern for a broad range of stakeholders. To identify and honour stakeholder aspirations requires engagement and a willingness to hear their diverse voices. According to Jeffrey Sachs:

Without restoring an ethos of social responsibility, there can be no meaningful and sustained economic recovery. [2]

So thank you Václav Havel and thank you Jeffry Sachs for being two more voices pointing to a better way to work and live together on planet earth.

Engagement and community building – the White Dog Café

In 1983 Judy Wicks started the White Dog Café in Philadelphia. It has become an exemplar for a community-based enterprise.

Where I live, community enterprise is slowly but surely being eroded as an increasing number of national or international chain stores supplant local stores. While this typically provides benefits such as cheaper goods the longer-term impacts are not beneficial for the local community (more about this in a later blog).

The White Dog Café started off as a restaurant, and remains a restaurant, but it has become the centre of a local network of suppliers, customers, employees and community interests. In the early years of the restaurant, Judy became increasingly troubled that the meat on her menu came from industrial farms. She changed to free range pork and then other meat and chicken and free range eggs. If produce is available locally, and is preferably organic, the White Dog Café purchases it in preference to imported food.

Initially Judy regarded locally sourced production as a point of difference for her restaurant, but her thinking evolved to consider the greater good and she went about engaging other restaurateurs in the concept. Her engagement with local farmers and growers created momentum for the establishment of the Fair Food initiative. Farmers and growers benefit from having a larger market for their produce locally. This animal welfare aspect of the White Dog Café remains one of her strongest motivators.

Networks of services

A restaurant depends on a web of services to operate. As Judy sorted out the produce for her menu, she became aware of a series of expanding possibilities to make the restaurant more sustainable and support the local community. She sourced renewable electricity and created a solar-heated water supply. Organic waste is composted and other waste recycled where possible. Local products are used whenever possible – for example locally produced soap is purchased for hand washing. For those products not available locally, such as tea, sugar and coffee, Fair Trade sources are used.

The invisible had works when we live in the same community.[1]

Staff also benefit from the sustainability philosophy – Judy pays a “living wage”. The Restaurant also supports a number of local community service projects such as Crime Victim Services and many others.

Business philosophy and selling the business

The mission statement of the White Dog Café is “Serving our customers, serving each other, serving our community and serving the earth”. Business decisions are based on serving the greater good, growing consciousness and increasing happiness.

After 30 years in the restaurant business Judy decided to sell the restaurant to help her focus on the promotion of sustainability. She wanted to keep the mission of the White Dog Café alive, so she found a local purchaser and retained the rights to the name of the business. To perpetuate the sustainability agenda she set up a Social Contract that keeps the White Dog Café on the same trajectory. The purchaser is able to set up other branches as long as they have 51% local ownership. This video outlines Judy’s perspectives, the restaurant’s operations and the Social Contract.

Above all, Judy has show how one business can generate social good by building rich networks in its local community. Do you know of other examples?

image credit: Real People Eat Local

Social capital and good books

“Social capital… reflects the community skills that have co-evolved with individual skills. People working together generate webs of social capital”. So say Jessica Lipnack and Jeff Stamps in Virtual Teams. Social capital is built on rich social networks.

It is a delicate thing. Social networks are forged from trust and as anyone who has suffered from infidelity in a relationship can tell you, trust builds up over time and but is very easy to destroy. According to Stephen Covey, trust becomes established when individuals demonstrate character and competence. Where these intersect trust and credibility is established.

Stephen Covey’s model of trust

We can easily see the beneficial consequences of trust and the accumulation of social capital when we consider those societies where trust and social capital has been shattered. Many of us can only imagine what it would be like to live in community where there is frequent violence, abuses and threats. In circumstances such as these the dismantling of social capital is accelerated when the state is perpetuating abuses.

Social capital is relevant for all social units: families, cities, businesses and nations. According to Lipnack and Stamps:

People generate wealth in dense networks of horizontal relationships in two primary ways because they lower transaction costs [and] increase opportunities for cooperation.[1]

A simple example is the knowing a friend will meet you as agreed, although a week has elapsed since the meeting was scheduled. You can probably think of a friend like this – and, by contrast, those that you would always contact to confirm the meeting. The extra workload, even if it is only small as illustrated in this example, reveals an added “transaction cost” to the relationship. Stephen Covey Junior provides another example in The Speed of Trust. A New York street vendor selling hot dogs found long queues dissuaded potential customers. He decided to enable customers to make their own change. This freed him up from dealing with cash and enabled him to provide much quicker service. His customers appreciated being trusted.

Now take these small gains and multiply the effect in large organisations (such as businesses) and their multiple stakeholders. The difference between a high trust and low-trust environments is clearly substantial.

Better World Books

Better World Books exemplify the development of social capital. They are a social business, motivated to do good. The profits flow, and they disburse much of them by supporting literacy initiatives around the world. According to Kevin Jones Better World Books “is now approaching $60 million in revenues with healthy profits and a compound annual growth rate of 35 percent. It’s donated more than $11 million to nonprofit groups helping to give the gift of literacy.[2]

Better World Books stock comes from donations from individuals, educational institutions and libraries. They are sold for a reasonable price to fund the company’s philanthropy. The Good Capital Social Enterprise Expansion Fund (SEEF) invested in Better World Books to aid it through its establishment phase. So we have a company who have a philanthropic supply chain, have staff who are no doubt inspired by the company’s mission, social enterprise investors, customers who buy into the mission and an increasing cohort of beneficiaries of literacy programmes. This is a potent recipe to build social capital that extends well beyond the boundaries of the company.

As Professor Muhammad Yunus says, every problem can be solved with a social business. The challenge for more conventional companies is how to use this dynamic and learn from its masterclass of engagement and social capital accumulation.

Here is a YouTube video of Better World Books. Note that the figures presented are four years out of date (reinforcing their incredible growth).

[1] Jeffrey Lipnack and Jessica Stamps: Virtual Teams: People Working Across Boundaries With Technology (2008) http://www.netage.com/pub/books/VirtualTeams2.html

Blue Ocean Strategy and Sustainability

You have probably heard about or read Blue Ocean Strategy by W. Chan Kim and Renée Mauborgne. It has been translated into 42 languages and sold over 2 million copies – so it fair to say it has made quite a splash. The authors came in a second spot on the Thinkers 50 for 2011. Their ocean metaphor is compelling – most businesses form strategy to compete in the red ocean. There is intense competition and there’s blood in the water. The smart ones migrate to new market spaces – the blue ocean.

It is exciting to look at this book through the lens of sustainability. A central concept is value innovation. A part of the process is driving down costs and increasing customer benefits, creating a new market space. The sustainability connection is the social good created.

The four billion people who make less than $2.00 a day are excluded from the market place. By driving down costs the poor can participate a little more in the market place and, more importantly, raise standards of living for their families.

There are some great examples coming out of the developing world – examples of innovation that we can learn from. Grameen Shakti, one of the family of Grameen companies, provides renewable power technologies to the rural poor in Bangladesh. To enable the poor to purchase biogas digesters or solar panels has required a suite of innovations creating an exemplary example of a blue ocean strategy. The panels are assembled and installed by women given appropriate technical training, also creating employment opportunities. The solar panels provide light at night, and improved fuel-efficient cooking stoves create a healthier home environment. Children are able to study in the evenings and the healthier air eliminates some health issues.

This image of a woman in a sari installing a solar panel on a Bangladeshi roof represents sea-change in the lives of rural Bangladeshi women. Opportunities for technical training and benefits generated by the new technologies transform lives. See more about Grameen Shakti in this YouTube video.

A “first world” example is the innovations created by Better Place through their radical business model for electric vehicles (EVs). Shai Aggasi has developed the concept of the “battery swap” enabling EV drivers to call into switching stations and quickly swap a battery. A core innovation is separating the cost of the battery from the cost of the car. He anticipates that economies of scale will reduce the cost of travel down to 2 cents per mile.

Shai Aggasi has integrated the value innovation concept into his business model. He recognises that mass adoption of new technologies depends on creating products and services that are cheaper than existing options. Your can learn more about his thinking at this TED talk.

This is the crux of the matter. Those introducing innovations into red ocean markets are either increasing buyer value or reducing price. Blue ocean innovators such as Muhammad Yunus and Shai Aggasi are doing both.

Unfortunately the companies that are selling EVs through conventional business models are relying on the red ocean strategy of increasing buyer value, but at significantly higher prices compared to comparable vehicle. I realise that they will want to recoup their investments, and that batteries are expensive. On the other hand electric motors and transmissions are simpler than internal combustion equivalents.

To reap the sustainability harvest, perhaps we will have to wait for developing world entrepreneurs such as Rajan Tata to deliver a blue ocean EV.