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.

 

 

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

Learning as a foundation for engagement, part 3: Tools

Earlier posts in this series introduced organisational learning and explored why the practice hasn’t had much traction in organisations. This post offers tools for learning processes.

1. Suggestion box blog

In this cartoon by Harvey Schwadron – an employee outside the boss’s office drops a suggestion into the suggestion box. Unfortunately, the suggestion box has no bottom and the suggestion falls into the resignation box directly underneath it. In organisations that don’t learn well, suggestions are ignored or, worse, those offering them are treated as troublemakers. Try a suggestion box blog – the blog administrator can receive suggestions and publish them, or enable the person making the suggestion to post directly. If there is an open culture, the blog can be open so others can comment. Responses or contributions from the company’s leader will add to its credibility.

2. After action review

Richard Pascale describes the after action review (AAR) in a HBR article Changing the Way We Change. The practice emerged in the US military and is used after military action or exercises to enable learning. Suspending rank is the key feature of the AAR as it encourages participants to review events in order to learn. The process is based around four questions that can be adapted to any organisation and is especially useful on completion of events or projects.

  • What did we set out to do?
  • What actually happened?
  • Why was there a difference?
  • What activities do we sustain and what activities do we improve?

3. Stupid hour

Learning doesn’t come easy when we take ourselves too seriously, or we are driven by the need to look good. Dorothy Marcic, in her ground-breaking book Managing with the Wisdom of Love, advocates a ”stupid hour” where staff get together, perhaps at the end of the week and ask “what are we doing that is really stupid?”

4. Lean thinking

Lean thinking, modelled on Toyota’s processes, provides scaffolding for learning by creating multifunctional teams to surface opportunities for improvements (OFIs). Here is more detail from a post by Alex Twigg.

5. Incentives

Some years ago Portland Cement near Whangarei changed their remuneration system from an over-time based system to a total remuneration system. Overtime hours were annualised and employees were expected to work up to 51 hours for their annualised salary, but could go home if they finished the work. This changed employee behaviour – under the overtime system, they would welcome breakdowns, as they would have to work longer, and therefore make more money. But under the annualised system, they were incentivised to work more smartly. As an example, loader tyres used to be frequently damaged by limestone rock. Employees wanting to get home quicker, welded wings onto the loader buckets to clear rocks away from the tyres. The employees got to go home earlier and the company saved money. Annualisation effectively opened up avenues for learning.

6. Appreciation

Appreciation is arguably the noblest form of communication. Too often, workplace communication focuses on fault-finding – concentrating on what is wrong, rather than what is right. When people are frequently criticised, over time they cease any meaningful communication with those who are criticising. This creates the antithesis of learning. In an environment of appreciation, people feel safe to make suggestions. Here is a link to an earlier post that elaborates on appreciation.

the communication spectrum

7. Undercover boss

The TV show Undercover Boss features businesses in the U.K., the U.S. and Australia. Across diverse businesses in these three settings, a consistent experience emerges – when the “boss” gets to know the people on the front line, they typically learn to appreciate what the workers do and return to their C.E. role much better for the experience. The C.E.s often enact employee suggestions, or include the employee in a project team. Here is Directv’s C.E. Mike White, talking about his undercover boss experience.

8. Learning from customers with social media

When I wrote this post about social media in February, this year, Stabucks Facebook page had almost 20 million likes. Now, 11 months later it has more than 26 million. Not all will provide useful insights for Starbucks, but any complaints can be quickly identified. Twitter serves the same purpose.

9. Values for learning

As with any other sustainable development in businesses and communities, better learning processes are underpinned by enabling values. Values that align well with learning include openness, honesty, integrity and appreciation. They are also the antidotes for defensiveness. You can probably think of others.

Do you consider your organisation is skilled at organisational learning?

Engaging stories: Fairtrade cotton

I mostly drink Fairtrade coffee, sometimes eat Fairtrade chocolate, but must confess, I don’t wear Fairtrade cotton. That will change now that I am reading Harriet Lamb’s Fighting the Banana Wars and Other Fairtrade Battles.

Struggling to stay above the poverty line

Harriet Lamb tells of cotton grower’s subsistence existence in Africa, where cotton supports about 10 million people. For countries such as Burkina Faso, cotton is the major export. Typically the growers live in villages that often don’t have direct access to drinking water, education and healthcare facilities – things we take for granted in the West.

African and other third-world cotton growers are enmeshed in the fabric of global trading dynamics. If they only had to contend with the vagaries of the weather and nature, and even the free market, they might be okay, but their problems are compounded by subsidies that wealthy countries pay their cotton growers. The U.S. Government subsidises their own cotton growers in response to falling cotton prices. When U.S. subsidies increased in 2001, U.S. growers responded by growing more cotton. Not, surprisingly, increased production saw the global price fall further. In 2005, the U.S. Government spent $4.7 billion on cotton subsidies, more than it spent on aid to Africa.

We also have spare a thought for the U.S. taxpayer here. The Government’s subsidies distort the market and impoverish parts of Africa, impelling Western governments to provide aid – so the U.S. taxpayer pays twice – through cotton subsidies and through aid. And it is even more crazy when the US subsidises Brazilian cotton farmers as part of a free trade deal. Unfortunately the Africans don’t have a free trade deal! The Fairtrade story, teaches us that aid is less necessary when factors influencing global markets are more carefully managed for all stakeholders.

Minimum prices

Fairtrade’s main mechanism for creating better returns for growers is a minimum price. This provides a buffer for growers and with the troughs in the market cycles eliminated, growers and their communities get the cash they need to raise living standards. Typically communities will invest additional income into clean and local water supplies and education.

As important as the material improvements, is the contribution the Fairtrade ethos brings to village life. For example, Fairtrade work to raise the status of women, through the agency of additional income and education. This video about Fairtrade cotton in Cameroon features the benefits to women. One of the women outlines the benefits:

The Fairtrade standards insist that women are in the group. The men had difficulty accepting this at first but slowly they realised that it could work. And now they own their own land… they are independent. They work their land, they go and receive their money alongside the men and this motivates others to get involved as well.

Commodity price increases

Recent spikes in commodity prices around the world have ameliorated the distortions created by subsidies. Demand for cotton has increased, as more people join the middle class, cotton production decreases and discerning consumers learn to favour natural textiles. This chart from the Index Mundi website, show the cotton price over the last fifteen years, revealing the sharp recent spike.

What I don’t know, is the impact this spike has had on third world growers. When commodity prices rise, growers don’t necessarily benefit. Has Fairtrade been able to ensure a fair share of the benefits get to those that need it most? And does it make you feel better about paying more money for a pair of jeans?

Engagement explosion

If you consider the relatively recent development of stakeholder engagement, its fair to say that there has been an engagement explosion. Edward Freeman first articulated stakeholder theory in his 1984 book Strategic Management: A Stakeholder Approach. It took a decade or so to emerge from obscurity and the concept had to survive criticism from those that saw it as a threat to the status quo – the primacy of the shareholder.

Engagement’s advantage is that it is organic in nature. People engaging become networked and engaging with others, opening further possibilities for engagement. Thus grow is exponential.

Fair trade

The growth of the Fair Trade movement is impressive. Harriet Lamb’s book Fighting the Banana Wars and Other Fair Trade Stories reveals explosive growth in Fair Trade sales.

The Fair Trade movement is a great example of the growth of engagement networks. The great achievement of fair Trade is in connecting the polar ends of the supply chain, the producer and the consumer. Before Fair Trade came along, most of us gave little thought to the origin of the bananas, or coffee or chocolate we consumed. But through the advocates of Fair Trade promoters we have learned that growers of these crops are often exploited by distribution and marketing systems. We have learned, for example that young people in African countries work as slaves on cocoa farms. Some of us know that coffee grown in the canopy of tropical forests creates great coffee in conditions that supports the ecosystem and is supported by that system. We don’t personally know the growers, but we learn that the Fair Trade system enables some of the money we pay for our coffee to help provide education for their families.

The Fair Trade example is just one example of the conversion of supply chains to value chains. I haven’t accessed product information using quick response (QR) codes with a cell phone, but the technology is there to provide more information about products and the people involved in their production, collapsing the supply chain and connecting producers and consumers.

The Internet   

The red line in the above graph shows the explosive growth of the Internet. We are still too close to the advent of this remarkable technology to fully appreciate the impact it is having on human interaction. I recall when I was writing my first book in the late nineties, I came across the Grameen story. I found Muhammad Yunus’s email address and asked his permission to use his story. He responded next day and a few days later the relevant chapter was written. More recently, I was able to connect with John Elkington through Twitter and ask for an endorsement of the revised edition of my book. He graciously agreed. Living at the bottom of the world, in New Zealand, I have been able to make connections that would have either been much more laborious or impossible in earlier times. Like many of you I engage with people in online communities across the globe. My potential to connect has exploded. Distance has been nullified and social levels flattened.

These are just two examples of greater engagement and connection and notice that they have happened in less than two decades. Profound changes are happening that will radically transform business and society for the better. I would be interested to know how greater engagement is happening in your life.