Robert Paterson: Health

Blogging - St Paul - The Real Needs of Business

Fri, 29 Aug 2003 11:57:54 GMT

New movements tend to stall when the "in group" want to keep the movement within the
"in group"

The same may be true for blogging. The number of people that know about what a blog is among my clients is very small. Intuitively I would say less than 2%. What would put them off? Anything technical. Blogging has to be made really easy.

Why do I mention St Paul? At the outset of Christianity there was a huge debate. The "In Group" as lead by the surviving disciples of Jesus insisted that to be a Christian you had to be a Jew. This meant adult circumcision for the men and backseat behind a screen for the women. Quite a "technical" hurdle!!!. Paul argued that all men and women should be able to become Christians - guess who won? Pride in coping with the technical sides of blogging is a block for take-up.

The real opportunity is when a group of "Ingroup folks" maybe like "socialtext" really engage with organizational life and find the fit. Step 1 has to be"Easy does it" Easy does it demands that anyone who can type can set up a good blog and that there are a number of great templates. We are exploring Typepad to see if we can make it even easier.

Step two has to be finding the immediate felt benefit. This is more challenging and I think demands that we find parts of an organization where building a community will help - maybe in the entire support area. This is where the whole KM issue rears its head. The idea of content management is an exceptionally stupid idea that flies in the face of how we understand knowledge. Only a small fraction of knowledge is explicit - the vast bulk is implicit - ie it is ten times better to talk to someone about an issue than to try and find what he has written about it. Who wants a manual when you can be walked through? BP has been a leader here in seeing that their key system issues is to find a way of connecting people with questions to people with answers. Each employee has a personal website that amongst other things has a lot of info about what they know. The deal at BP is that if you have question you search for the person.

Why should we care anyway? Blogging is our path back to being human at work. Blogging reveals who we are to not only others but more importantly to ourselves. For the first time mankind - the great tool maker - who has used tool making ingenuity to make the world and himself into a tool, or a thing, has created a tool that renews and brings back what it is to be human.

So like Paul - we are faced with an historic choice. We can relegate blogging to geekiness and tool making or we can work to change our relationships back from machine to human.

What do I mean by this bold statement? We can change democracy by making it essential for politicians to be real and to listen to us. We can get the issues that make sense on the table other than spin. We can make management of organizations transparent and give organizations a human "Cluetrain" voice. We can change how we learn - from each other rather than from institutions. We can change healthcare by empowering fellow sufferers to help each other rather than to rely on the priests of medicine. We so change the world as Paul did.

Blogs for What Business?. Jimmy Guterman's new piece on business blogging (sub. required) is sure to cause a stir. He charges the blogging community as being "self-absorbed and elitist" and says its not essential for business. He cites a Forrester study to back up his claims:

You don't have to believe me on this. Finally, some data asserts that blogs are hardly a popular pursuit. If anything, blogging is more marginal than its critics contend. Forrester Research (FORR) conducted an online survey of 3,673 people and found that 79 percent of its respondents had never heard of blogs, 98 percent had never read one, and 98 percent said they'd never pay to read or write one. Blogs can be wonderful things, but if a mere 2 percent of Internet users read blogs, the pastime is far from mainstream. The Forrester survey notes that the typical blog reader has been using the Web for an average of six years. For the most part, blogs feature the Net elite writing to the Net elite. This continues to be the case only as long as the elite are underemployed.

I believe what Jimmy is saying is that there isn't a consumer market for blogging and that it isn't essential for businesses to address it. The problem is we are at the very beginning of a technology adoption lifecycle. Some serious companies have forecasted this market to grow and made their bets accordingly. Every time a journalist tries to wrap themselves around the existing market, what's visible are early adopters. What stands out are the leaders in using blogs for publishing, who benefit from preferential attachment as the earliest entrants. And if you take the innovator dialogue to seriously it looks like a one ring circus.

The other story folks pick up on is unclueful attempts by businesses and PR firms to market to bloggers as an emerging and influential segment. Any attempt to treat bloggers as a segment will fail. Today the influence of participants who act more as producers than consumers is the attraction. The number of participants is growing at 400% per year, and that's before AOL's entry.

But the real story in the consumer market is how increasing numbers of real people are using blogs , but as a way to communicate an form their own communities. Its that skinny tail of the power-law distribution that's going to wag the market. A way to share with friends, communicate post-by-post and remain open to new people joining your community. Conversational Networks provide the most value to your average Jane.

Rick Bruner does make the case that there are lots of businesses using blogs in the consumer market and points out this is like the web in 1995 and where the weblog as publishing market is headed. And many of them are making money. I agree that more evidence in this area would help, always does, but give it time for these new ventures to tell their story.

There is another story of weblogs and business that is less visible because the real action is behind the firewall. At Socialtext we are adapting weblogs for use within enterprises. Weblogs are one Enterprise Social Software tool, because they are necessary but not sufficient for communication and collaboration.

The enterprise market is entirely different than the consumer market. What is in common is an efficient, and dare I say fun, way of having conversations that contribute to productivity. Maybe its time we start telling more of our customer stories, but the distinction between consumer and enterprise needs to be made. [Corante: Social Software]

PEI Fall Election 2003 - The Real Platform and the Real Issues

Sat, 23 Aug 2003 14:43:11 GMT

Questions for all those who plan to run for office in the upcoming PEI Election

1. The economy - In the next 4 years (the life of the government) the potato processing side of our economy will collapse and will take down its surrounding infrastructure. As it collapses - US markets will close, there will be a drought/flood/ more disease etc, it will try even harder to survive and threaten our water and environment even further.

Will the new government use up all its resources to "save the jobs" or will it work to create an alternatives such as a local food system?

If they choose to "save the jobs" they risk the new future of tourism - eco tourism. A last ditch attempt to "save the jobs" will threaten in turn our landscape and will turn away the real future for this sector. The days of the beach holiday where families are satisfied with a cottage with 7 others on the Brackley Point Road are over as well - demography and shifts in values are seeing to that. Golf is also oversold and over capitalized.

Will the new government spend all their time and money in keeping this side of tourism alive and "saving the jobs" or will it support eco tourism that fits who we are and where the market is going?

We are seeing the end of the lobster fishery this year. The processors have not sold the spring inventory - changes in world taste and too much of a production based approach - the fall season has seen stocks collapse. The industry is also over capitalized. There are too many mussels in the bays and they do not have enough feed - notice how small they are. There was huge die off of Malpeque oysters this spring. Are you looking at the reasons for this failure?

Will government "save the jobs" in the fishery? There are already $100 million in loan guarantees out to this sector alone.

Will we waste our limited resources on saving what cannot be saved or will we build the new?

Do we understand that it is our economy that produces the cash to pay for the education and healthcare that we feel is so important

2. Energy - Do we understand that we can break fee from oil by going to wind? Do we understand what this type of freedom might mean. Who chooses gas and oil over wind? Tell me why you prefer to be a slave to the oil industry when we could be free?

3. Education - is the issue about keeping schools open or is the issue how badly our kids are doing? Why is there no data available on drop out rates? Why will we not allow measurement? Why do we sit by and allow 40% of Islanders to leave school basically unable to read and write. Is the issue money? In the US they have poured money into this problem and have seen no improvement! Why are boys doing so badly? If more than 30% of boys are on drugs to get them through the school day is it the boys or the system?

Answer these question please Mr Politician before you waffle about money, school opening and class size

4. Health care - Our health care system now costs over 400 million a year and is growing exponentially faster than our economy. If this trend continues in 4 years time Healthcare will cost more than 60% of our budget. Don't talk about services anymore - tell me if you understand this dynamic! Tell me how you see what we have to do to get this growth stopped. Tell me what your plans are if you fail.

Why do you not talk about the fact that we spend half the total lifetime spend on care in the last 6 months of life in a vain attempt to defeat death. That is about 200 million a year! Tell me how you plan to help us and the medical profession deal with this most important cost driver.

Tell me that as our population ages and we have the oldest group in North America that you have a strategy for seniors that will shift them from being dependents to contributing members of society.

Tell me that you understand that drug use is growing at more than 9% compounded and will soon be the # 1 cost in the system. Tell me that you understand that most of this drug use is for lifestyle issues such as depression, hypertension and cholesterol. Tell me that you understand the research that these so called threats are minor when compared to our personal ability to cope.

Tell me that you understand that most of our ability to cope, to learn and to think is set by the age of 6. Tell me how you intend to shift resources to get behind this knowledge.

Summary

Tell me that you understand that it is not business as usual. Tell me that you understand that we are coming to end of the industrial system Tell me that you can see how fragile our world is today. Tell me that you would, like to ask us to help.

My sadness is that of course the election will not be fought around these questions but about the same old stuff of my job versus yours - of being bribed with our own money - of offering simple solutions to complex problems - of blaming the others.

It is even more sad that we have run out of time. In the next 4 years - the life of the next government - the forces will converge. Our resource based economy will fail and our primary social institutions will fail as well.

But we can surely attempt to change the political conversation? Is this not our responsibility. Politicians do not lead they follow.

Can we not use the tool of the internet to talk about the real issues? Why not pillory those who talk rubbish. Why not support those who talk sense?

No safety in the familiar in a storm

Tue, 12 Aug 2003 14:56:03 GMT

Several years ago, a friend of mine came close to breaking free from the institutional life. He had a foot in each place. But frightened by the unknown, he pulled back into the world he knew - confident that he was safer there where his mastery lay. Last week he was fired.

In my own life and family too we have a recurring story, a Greek tragedy, where the pull of duty and obligation to the familiar overwhelms the preservation of self. The outcome - an early death for both my father and grandfather. It seemed to be their only exit. I thought that I was exempt from this story but find that I am well into it.

I too like my friend have a choice. The paradox is that in a turbulent time, the greatest risk is in hanging onto what seems safe. The greatest safety - to reach into the unknown. This is surely not only true for each of us as individuals but also for organizations.

Here is how Herman Melville describes this in Moby Dick

"The port would fain give succor; the port is pitiful; in the port is safety, comfort, hearthstone, supper, warm blankets, friends, all that's kind to our mortalities. But in that gale, the port, the land, is that ship's direst jeopardy; she must fly all hospitality; one touch of land, though it but graze the keel, would make her shudder through and through. With all her might she crowds all sail off shore; in so doing, fights 'gainst the very winds that fain would blow her homeward; seeks all the lashed sea's landlessness again; for refuge's sake forlornly rushing into peril; her only friend her bitterest foe! " Moby Dick - The Lee Shore Chapter.

Worried about cholesterol? Worried that you cannot afford the drugs that you think that you need? - Don't worry be happy!

Sat, 02 Aug 2003 19:38:19 GMT

Here is another view from the Whitehall study. What is shows are the rate of death from Coronary Heart Disease (CHD) your rank in the hierarchy and the risk factors. Look to the right at the longest bar chart. This shows that you are 4 times more likely to die form CHD if you are at the bottom of the pile than at the top. See that thin black line at the foot of the chart - that is your risk factor to scale if you have high cholesterol. yet what is the main topic of your conversation with your doctor? What are the best selling set of drugs, after anti deprressants? Pills to lower your cholesterol. The blank in the file (actually white so it doesn't show) is high blood pressure. Taking pills for hypertension? Even smoking is not too bad.

It's easier for us to take a pill I suppose than to face reality about our lives. Are we mainly slaves or free - that is the health question I think.

There is no doubt that many drugs are very useful but are the the only way to see health improvments?

I love this slide. It shows the relative decline of TB. Most of the battle was won in the public health sector way before the introduction of antibiotics in the 1950's.

How we feel about ourselves is another important factor.

Here we see the amazing rise in the crude death rate in Russia after the collapse of the Soviet Union. What is the main factor. A loss of identity. We see the same prcess in our native population in North America.

So what's my point? One of the factors that is causing our healthcare costs to exceed the rate of groweth of our economy is the rising cost of drugs. We seem to belive that it is only drugs that keep us from death's door. This is especially true for seniors. How do we change this perception?

Identity - Our most important need? Does blogging make you well?

Sat, 02 Aug 2003 12:49:52 GMT

I was struck this week by seeing "Augustine's wall". In the work I am doing on health, I have come to understand that one off the most powerful negative forces on our immune system is when we lose our sense of control and identity. The modern bureaucracy strips us of both. Hence now 17% of payroll is the direct costs of absence and health in the modern workplace. Just before you scan on past this -17% OF PAYROLL!!!!.

Most disease in the developed world is chronic. Diabetes, back problems, depression. They cannot be "cured" by using the germ theory.

This type of disease is the largest cost in the modern work force and is also driving the revenues of the drug companies who have found a gold mine in problems that cannot be "cured". Drug cost are rising at a compound rate in excess of 9% and will move soon to the top of the list of costs in the health system.

But actually it is Augustine that has a sense of where we could more profitably look for help. The emerging key to chronic disease is culture. Our immune system is compromised when we live in a culture where only a few have voice and control - the modern bureaucracy. We are also learning that the same conditions apply when we look at societies. Those that are very top down such as Sicily have much worse health and economic outcomes that say the north of Italy that has a tradition of strong horizontal links of self help. We are also learning that the same is true in families as well. Egalitarian family cultures drive the best development for their children. All this is coming together in a grand theory of culture/the immune system/development and coping.

Here is Sir Michael Marmot, the world's leading workplace researcher on the topic:

The question is what is it about position in the hierarchy that determines different rates of disease?

And given that, the hierarchy in disease does change. All societies may have hierarchies but we know that the social gradient in disease is not fixed. It?s bigger in some places than others and it can change over time. This could be that the magnitude of the hierarchies change, but there are always hierarchies. But more importantly, it suggests that it is about where you are in the hierarchy that's related to disease and can we do something about that?

So you ask is it money? Is it prestige, self esteem? And in fact what I think it is has much more to do with how much control you have over life circumstances and the degree to which you?re able to participate fully in society..?

Here is what this means in real life.

Here is a graph showing the Gradient in mortality in the Whitehall Study that looked at the UK Civil Service over 20 years. In the UK, Administrative would be the top of the heap. People at the bottom have 4 times worse outcomes. These forces are much more powerful that the factors that we currently focus on such as smoking, obesity etc.

Putnam makes the same case for the impact of community on health as well.

The traditional "paternal cultures" such as Louisiana are at the bottom where only those at the top feel they have a voice and control, and the more egalitarian cultures such as Vermont are at the top where many feel that they are in charge of their lives and that they have a say. Again these indentity and control forces are huge.

Wilms at UNB has found the same correlation in family culture as well. Those families with very traditional authoritarian cultures shut down their children and set them up for very poor development tracks. By the way really permissive parents are almost as bad.

Augustine is so on the money! My sense is that in the next 20 years we will develop an approach to health that is largely governed by our emerging understanding of how our immune system is connected to our sense of identity and voice. Paradoxically, similar "Public Health" approach in the late 19th century hit infectious diseases on the head. Clean water, good sanitation, the end of child labour, the introduction of public schools etc all contributed to a huge reduction of infectious disease well before the introduction of anti biotics. I find it interesting that as parts of society break down that diseases such as TB are on their way back now.

My hope is that as we understand the issues of control and voice, that we can shift from medication to having a better life as the "cure".

Some Doctors are great

Tue, 15 Jul 2003 20:59:44 GMT

70% of the US healthcare costs are driven by chronic disease. Diabetes would be at the top of the list. Read how a group of health professionals are dealing with this in the US. Would be great here

Magic Numbers and Social Organization Is there a science here?

Sun, 13 Jul 2003 17:54:21 GMT

I am reading Simon Singh brilliant book on Maths "Fermat's Enigma". (See link) Fermat's problem is based on the one equation that even the most dunce maths brain such as my own understand - in a right angled triangle, the Square of the hypotenuse equals the sum of the square of the two other sides. - Fermat's problem is based on this simple equation. But that is not my point today. My point is that Pythagoras was struck by how the natural world, such as music and so on, was run by a series of numbers. Numbers can be found at the core of most natural phenomena and relationships. Did you know that you can calculate the actual length of a river by multiplying its crow's length, the point to point, by Pi (3.14)? How weird!

My aha for today is that, why should not human relationships be also governed by numbers? If so, we are underplaying the importance of magic numbers. Why are nurses so unhappy? Might it be that they go to work as groups and not as teams governed by the rules of magic numbers? Why is there bullying at school? Might it be that we do not organize them by using magic numbers? Why do many of our social and work organizations need so much bureaucracy? May it be that we do not use Magic Numbers. Why do all armies have the same core organizational structures of 8 - 15 - 35 -150 and 500-600? Might it be that they have found out intuitively that these sets work best under stress. Why are all HG groups functions of 15 and 35.? Why are larger tribal groups not more than 500? Why is 150 such a perfect number for getting complex work done?

I am beginning to feel that much of the inhumanity and stress in our work place is the machine culture that pays no attention to these hard numbers.

Fathers and Sons

Sat, 12 Jul 2003 17:29:56 GMT

It is only fair, if I was writing about Mothers and Daughters, that I should mention Fathers and Sons. There appear to be two areas of angst that I hear about the most.

The "Lost father" and the "I'll show him father" .

The Lost Father is a set up where the son feels that he never really knew his father. Where he saw his father have fatherly relationships with other young men - especially at work so he is aware that his father has the capacity to be a father but this relationship does not happen between the true son and the true father. The saddest example of this is Col John Boyd (the father of the OODA Lop and Shock and Awe) who was one of the great mentors of the modern era but who ignored his own sons. In the final irony, as he lay dying Boyd called out to his intellectual sons as his natural son sat by his bed in the vain hope that maybe, at the moment of death, his father would acknowledge him. For many of us in this category of sons, I am one, much of our adult life is a quest to find a father substitute. Sometimes these relationships can be nourishing and good - especially in the early years in boyhood or early adulthood. But others, if you keep on seeking into adult life, can be based on trying the same failed tricks to win the attention of the fake father that failed with the real father. If you are lucky, one day you find an older man who tells you that it is time to grow up and look after yourself. Thank you Fraser!

The "I'll show him father" - good examples are Rupert Murdoch and Ted Turner. Both men had successful fathers whose constant discourse to their sons was that they were no good layabouts. For these men this was the lash of ambition that drives then so hard to "show him" that he was wrong. Like much mania, the it appears that the pinnacle can never be reached and that the need to show him never ends. The sadder side of this set up is the son who believes his father's sentence of failure and acts this out his entire life.

Are there fathers whose relationships fit their sons needs? I am sure there are - but good stories are never about comfort

Natural Capitalism - Paul Hawken comes to PEI August 13th

Fri, 11 Jul 2003 18:41:00 GMT

"The Laws that we are ignoring determine how life sustains itself. Commerce requires living systems for its welfare -- it is emblematic of the times that this even needs to be said. Because of our industrial prowess, we emphasize what people can do but tend to ignore what nature does. Commercial institutions, proud of their achievements, do not see that healthy living systems -- clean air and water, healthy soil, stable climates -- are integral to a functioning economy. As our living systems deteriorate, traditional forecasting and business economics become the equivalent of house rules on a sinking cruise ship."

Being an Island and being dependent on our natural resources for the 3 pillars of our economy, Agriculture, Tourism and the inshore Fishery, PEI is on the knife edge. Our use of the traditional industrial model has stressed all the connected systems to the limit. How to save ourselves is the question. Debates about the environment are usually futile arguments from one group who says that we cannot change because if we do, we will lose all the jobs and while the other says that we should not have an economy at all and merely save the environment. The result is that we remain stuck.

For many years Paul Hawken has being saying something different. His message is that an economy is essential. The issue as he sees it is not to chose between jobs and the planet but to have both. The work is to design a new type of economy that works according to the laws of nature and physics. Hence the term Natural Capitalism.

Paul is coming to PEI to speak formally to the National Round Table on the Environment and the Economy on August the 14th. But he will speak to the public of PEI at UPEI on the evening of August the 13th.

Over the next few weeks I will post as many good articles that I can about what we face here as issues and also what we now know about a new design that may help us. Please help me by adding your comments and by leading me to other good articles.

Blogging and becoming Human

Thu, 10 Jul 2003 21:43:05 GMT

I was being interviewed today by a PHD Student who is working on the topic of Communities of Practice. We had a bit of an aha that I wanted to share

It appears that the corporate model that most of us work in now squeezes out our humanity. We develop machine relationships - even odd corporate voices - not simply a use of lanaguage that is not human as described in Cluetrain, but a manner of speaking a "dead sound" where our real personality has been excluded as has emotion and feeling.

This machine world is causing us to become ill and depressed. I speculate that as we assume this corporate personality that it takes over our whole life and affects our marriages and our relationships with our children.

No wonder marriage is failing and our children are in such trouble. We act in this impersonal and unreal way in our whole lives. We even act like this to ourselves and no longer have a real relationships with ourselves.

How can we learn and experience being human again? What is the essence of being human? It is surely to hear our real voice. What does blogging do? It allows many of us to develop this voice. Blogging can enable us to become human again.

Not a small issue.

Losing a Child - Loss and Suffering - Nature's Power to Heal

Mon, 07 Jul 2003 10:51:10 GMT

The Lake in fall

The International Children's Memorial Place opened this weekend on Prince Edward Island.

As a parent I cannot imagine how I would cope with the loss of Hope or James. I think that when a child dies, part of us dies as well. For me, as with many others, formal religion offers little support. But Nature can and does.heal this wound.

It is not just family who are hurt by the loss of a child. It is hard to reconcile the loss of a school friend and this happens often. Many of us are confronted by the early deaths of school friends in car accidents. My roommate at school Jamie Borwick died in a car with his brother Freddie on Freddie's 21st birthday. I was working in Botswana in the desert as a diamond prospector when I heard the news - I was 18. Living in the open and being able to look up at the star filled night sky helped me see that Jamie had made the shift into eternity.

Bill MacLean is a remarkable man who lost his son a few years ago. His dream was to create a place where family and friends could connect with the power of nature and , if they wanted, to each other, in surroundings that were "healingl". Bill has done this. Located at Scales Pond on PEI, the International Children's' Memorial Place (ICMP) is I think the most beautiful place on a beautiful Island. The lake is like the lake where Arthur found his sword.Excalibur. Early on a summer morning, the mists hover on its surface. The Dunk River travels majestically in a cathedral of trees. There is a pathway along its length. The water from the lake rushes through a dam and a fish ladder boiling with life and energy. You can plant a tree where we hope to create a new hardwood forest. There is plenty of space to be alone and there is a the choice of meeting other people. You can bring your dogs, swim and picnic. You can just visit a special place. You enter the "Kingdom of Nature".

The site is about 30 minutes from Charlottetown and from the Bridge - in the centre of PEI. See the maps on the site.

The Dunk

Not the software but the business model

Sat, 05 Jul 2003 10:39:02 GMT

Tim O'Reilly on generating value with commodity software.

Tim O'Reilly: "somebody gets a critical mass of customers and data and that becomes their source of value.

On that basis, I will predict that -- this is an outrageous prediction -- but eBay will buy Oracle someday. The value will have moved so much to people who are not now seen as software suppliers."

.... "Amazon is the furthest along this path, in a lot of ways. Amazon really understands that they are becoming a platform."

[Micah's Weblog]

Great article! I am convinced that we can now 'see" the new business model and it is made up of two components - build to order - the primary Dell focus and build community - the primary eBay focus. Amazon has both of these aspects in its model.

New entrants that pull this new model off well will destroy the traditional competition. Two areas that I think are most open to this attack are post secondary eductaion and chronic health care.

Why do I think this? More later

Regular Exercise - A Habit?

Tue, 01 Jul 2003 15:45:48 GMT

Why is it that I am 53 and have ignored well-intentioned and factual advice for 30 years to take regular exercise? I know that it will be good for me. I know that this is not baloney like many diets are. Taking more exercise is unquestionably good for me. For a while, I buckle under the social pressure and try it. I go to the gym, buy a rowing machine. If the barrier was only awareness, I should have taken it up years ago.

Why is this important? Because our health system will buckle soon if we don't find a way of living better. On PEI 59% of Islanders are overweight and the trend for children in particular is frightening. This is a health epidemic for the developing world. We are trying lots of things and making lots of excuses for why we are making no progress - the trend is getting worse at a non linear rate.

There are lots of theories for why we participate so poorly in taking exercise. The influence of TV as a passivity driver. The lack of organized sport at school. Busing at school. The lack of time in adult life because the demands at work are so great. The lack of coaching and facilities - if only we had a community pool, gym track etc. The diversion of sport money for the masses by a focus on elite sport etc. I wonder if the answer is both simpler and more complex than this?

I have been talking to my friend Brian Chambers and our bottom line as to why we have become the most slothful group in history is rooted in two questions. - Is taking regular exercise a habit? Is not taking regular exercise a habit?

Think a bit now. Is your day not right without exercise or is taking exercise an interruption to your day? Do you have withdrawal symptoms if you do not take exercise or do you feel worse if you do? These feelings are symptoms of habits. Habits are hard to change. You are a smoker and you know you should quit but cannot. You drink more than you should but you cannot stop. Merely having a lot of information is not enough to stop an ingrained habit. Acquiring a new habit is equally a challenge.

If taking/not taking regular exercise is a habit then much of how we have approached the issue of participation in regular exercise is probably not going to work. This is quite a statement - so let's do a bit more digging.

Why is it that we see only a few of us - we used to call them Fitness Freaks or Nuts - come rain or shine pounding the roads? Why do some some middle-aged men still get out every week in the season and play hockey while most of us only watch it?. Why do some women have to go to the gym every day and others not? Brian and I believe that those who take regular exercise have a habit. They have a need to take exercise every day. It is part of their whole life - they cannot imagine not taking exercise. Regular exercise defines them - it is part of their identity - it is who they are.

I bet that the opposite is true. Some people cannot "see" themselves taking exercise. Let's look at me and see how hard it is for me to take up this new habit and to break my lifetime habit of not taking exercise.

I have never taken to the habit of regular exercise. I think I have to go back to my early days to find out why. My parents did not take it seriously. They in fact sneered at it. Any prowess in this regard was ignored at home. In my home the habit was to use the mind. This is where the family reward system kicked in. "Sport" at home was winning the argument, breaking into the conversation or being seen as amusing. Secondly I had low conventional physical skills. In particular I have very poor hand ball foot coordination. I had to play "sport sport" at school but for me with no natural aptitude, "sport sport" was for me an exercise in humiliation. In primary school the team would groan when I was picked usually - last. At Harrow, I was the star of the 5th 11 in cricket. I dreaded Sports Day at my prep school where the only event I could be in was the 200 metres where they put all the slobs. Sport was defined in my youth as a team sport that usually involved skill with a ball of some sort. I can't do this. Now if I had been introduced to yoga, tai chi or rowing I might have found a mind/body sport that fitted me - but that was not the culture of sport then nor is it now at schools.

I never developed the habit of exercise as a boy. In fact I developed another habit - a lifelong dislike of using an awkward body and a lifelong love of the world of the mind. I have instead the habit of reading - in a poor week only one book. In a good week maybe 7 books. (This has been a good week) Many of my athletic friends tell me that they do not have the time to read. I sense that we are at two ends of a polarity.

There are the habits of the mind and the habits of the body. There appear to be extreme positions for each habit. If you are extreme at one end it may preclude you having time to indulge in the other. Some manage both but I sense that there is only so much time. Then there seems to be a huge group in the middle of people who neither read nor take exercise.

Habits can be formed and broken. At the right time habits are easy to form. All established habits are very difficult to break or change. It is important to consider this if we want to find a way of increasing the overall participation of people in regular exercise.

When are many of our habits formed? I suggest to you that regular reading and regular exercise are both habits that are mainly set when we are very young? Homes with no books rarely produce compulsive readers. Homes with no trophies rarely produce folks who define themselves through the use of their bodies. I am sure there are exceptions but this is my observed experience. I point out the home because we currently look to school and to the workplace as the frontier for improving participation. I am not saying don't try there. I am suggesting that we look earlier as well.

Breaking habits is so difficult. If not taking exercise is a habit then exhortation and more information will not get us to change. How easy is it to acquire the habit of literacy as an adult? How easy to give up drink or to give up smoking? Breaking bad habits is very hard. It took my father's death to give us as a family the motive to pull back on our drinking.

Some questions for you:

Do you take regular exercise? If the answer is yes or no - Did you have a role model/support at home? Did you have a natural aptitude for ball and team sports?
Do you have a habit such as smoking or weight or drink. - Can you give this up? Has it been easy to give this up? Could you do this without a support group? What type of support group might you need - of peers or experts?
Are you a team sport person? If you are when did this begin and why
Do you like individual activities? If yes when did this begin and what influenced you?
Are you a big fan of professional sports? If so, did elite sport get you involved in taking exercise yourself ? If yes - what age were you when you gave it up and what do you do now?
Did you play pavement hockey or some kid organized sport when you were young (skateboarding?) If yes, what do you think of adult organized sport?

Please help Brian and I with these questions and with our main thesis that regular exercise is a habit. Brian is the Chairman of Sport PEI and is tasked with the challenge of finding a way to take Canada's most inactive and fattest province and making it the opposite - no small thing. We are convinced that doing what we have been doing but harder will not work. So we are going outside of the box and asking ourselves the odd question - why if we know that exercise is good for us are we not taking this advice.

If we are right and the core issue is habit, then we will have to develop strategies to encourage the formation of the habit. This implies working with the families of very young children before they get to school. It implies finding out how to motivate parents to behave differently. What would be a motivation that would work?

We know that many kids will self organize. Ball hockey and skateboarding are being surppressed in the guise of safety and order. Should we not look at the effectiveness of kid organized sport?.

It implies developing strategies to do the really hard stuff of helping people like me to change a habit of no exercise. How could we do this? What are the lessons of smoking and drinking that may help? What is it about schools and the workplace that are barriers and what can we do there to help?

What are the convenience issues? Where are all the places and where is the time? Why do so many schools close their doors and hence gyms and pools after 3pm? Whose school is it anyway? What is the reality of our climate for taking regular exercise where we have 6 months of winter? Can we take back the time between 2.30 when school finishes and say 5.30 when 80 % of parents return home and fill this with a fun time for exercise? Can we fill the 6 weeks of summer vacation when parents are working with a fun time when kids take exercise. Can we make it convenient to nip out for lunch at work and take exercise?

Healthy Living - If I was the Premier of PEI

Fri, 20 Jun 2003 11:14:10 GMT

If I was the Premier sitting in cabinet and I was serious about Islanders becoming healthier what would I do?

I would divide the issue into two. I would look at what Government could do directly and then I would look at how government could influence behaviour indirectly. At the core I would position the issue as being behavioural and I would focus the direct and indirect work on levers that influence our behaviour.

The Direct Approach

Sugar

The research is in that sugar and simple carbs are the main culprit in both adding the pounds and in creating the addiction and system changes. The best analogy is tobacco. For years we all thought that smoking was cool. Now we know it is at the heart of our public health crisis. The same is true for sugar. We all grew up drinking pop. Smart parents gave their children juice in the bottle. As we became time- stressed, we relied increasingly on processed foods where a large ingredient is always sugar. It will be Government's job to help us all understand that sugar is possibly a larger threat to our public and personal health than tobacco. The irony is that we have done this job for fat but our fears have largely, not entirely, been misplaced. Low fat as an idea has been a goldmine for the food processors.
I would start with getting agreement with the other Premiers who all have health systems that are groaning under the pressure, to begin the same type of information campaign about sugar as with tobacco - the objective will be to shift our perception that sugar is ok to that it is a risk. We would then nationally build a campaign using real people whose lives had been turned around by getting off a high sugar/carb lifestyle to tell us how much better they were. This would not be a campaign of experts but of neighbours. Key to the campaign would be mothers talking to mothers about the risks of a high sugar diet for their kids and giving them tips on the alternatives. The habits begin here. What failed in tobacco was the expert talking down. What worked was a neighbour telling us that we as smokers would harm not ourselves but innocent bartenders.

With a shift in public opinion we would have the room to begin to act.

School

Kids are bused home on PEI between 2.30 and 3. Most parents work and do not get home until 5.30 - 6. Madness! I would set up a sports program for all kids that would extend until 5pm. There is no shortage of gyms, rinks grounds. The shortage is a universal program of sport for children that fits the school day and that fits the reality of the workday for parents. The objective is twofold to significantly increase the weekly rate of activity and to set the habit of taking exercise as a lifetime habit
- This strategy would be inclusive and broaden the effort from elite sports and elite players. It would still get behind the school teams but would offer a comfortable place for all types
School meals - I would set up a healthy breakfast club at school. Many Kids miss breakfast - time pressed, no habit or worse no money. Breakfast is arguably the most important meal of the day. This meal would be billed to public health. This would be a real meal and would avoid Mr Kellogg and Mr Tim Horton.
Ban soft drink vending machines - Coke has preyed upon poor school boards with deals on vending that are driven by volume.
I would teach cooking and nutrition as part of the core curriculum especially for the younger kids. One of the reasons so many eat only processed or junk food is that no one knows how to cook anymore. Again we aim to create the habit of cooking and we teach nutrition not from a book but from learning how to cook well and to enjoy what we have cooked.

Waste, Labelling & Taxation - A Counter Attack on Food processing

As part of my communication partnership with the other premiers I would also get national agreement to push back at food processors. They have taken over food and they spend over 10 billion dollars a year in the US to persuade us to eat their products. I would move on two fronts. Packaging and labelling. - I would use the inventory management software of the distributor to track the items and I would give the industry 3 years to eliminate waste that could not be recycled easily and to reduce waste as a percentage. After three years I would double or triple the PST on packaging that failed this test. In other words I would push back at waste at the source. At the same time I would demand, as with tobacco, that health warnings be put on all processed food and in places that served it that contained high levels of sugar/Carbs/trans fats. So at MCD you would see a sign on your pop cup that told you that you were taking a big risk in drinking more than one of these a day. Your pack of Sugar Pops would have a picture of a person giving themselves an insulin shot and so on. Very significantly I would include formula in this program. Formula should have a large health warning linked to obesity.
I would not change the tax rates for three years as so many are addicted and are poor and feel that they have no alternative. But then after the 3 year public relations war, I would bring in a series of significant tax hikes. Significant so that there would be no room for adjustment. Such a health tax might be a flat tax of say $2.00 an item so a can of pop would go up $2.00. I would also ban all ads everywhere that promoted high sugar/carb/trans fat foods
- Of course the food industry will go nuts. This is why only a national agreement will work. The alternative is to pay for the costs of an obese nation. We are winning the war on tobacco - why not for food? Let's be clear here, the food giants are acting in their own interest and not ours.They are the main driver in the dietary problem that we face as a society. They can be part of the solution as well. The smart ones will take that root- our time pressure will not go away - there will be a huge market for healthier alternatives

The Indirect Approach

Young Children - We have to change behaviour and to set new habits when we are malleable enough to respond. This means a focus on very young children and their parents. Most of the current effort on obesity and many other issues that are most plastic in early life, such as literacy, are being tackled with a focus on adults where changing behaviour is most challenging. I think that this is because those that have set themselves up as the experts, such as the university and the Heart and Stroke folks, obviously live in a world of adults and would like to help their constituency. But if strategy is defined as making the best choices, then we have to shift our focus to young children and those that influence them most, their family, the school system and the ad budgets of the food processors

Prenatal classes are an excellent channel. Parents are at the most ready to learn and have the most energy. The whole issue of diet needs to be explored perhaps with the meeting taking place around a kitchen table as well as on the floor with pillows. All aspects of diet especially the breast/bottle issue need to be explored
Family resource centres should be identified as the next channel as they influence parents right after they have their babies
Day care should be examined to ensure that it is aligned as well.

The point being that by the time children get to school in grade 1, there should be 7 years of focused effort on setting up good habits at home.

This is a strategy. What do you think of it?

How we eat - Changing the habit of a lifetime

Fri, 20 Jun 2003 09:29:38 GMT

Is the PEI Healthy Living Strategy a Paper Tiger or will it help?

The questions we need to ask are

1. What is the trend for obesity - frightening about 59% of Islanders are at least overweight

2. Is the trend accelerating or flattening out - accelerating exponentially

3. What is the potential impact now and in the future - one view would be to look at the incidence of type II diabetes and its related costs? Our health system will be overwhelmed. Type II diabetes has been normed from being a rarity to being on track to include 30% of the population. It has a myriad of poor outcomes and side effects and consumes a huge amount of system resources. It can be mitigated though by a radical change in lifestyle - giving up carbs and taking more exercise. Hard things to do until we have the motive of diabetes. But even then, many are so habituated that they cannot change.

4. What are the key factors for a lifestyle - habits! How and when are these set? Is this genetic or habit based? What are the 2-3 habits that are most deleterious? I would look at the amount of sugar/carbs that we feed to kids - tests with rats show a high sugar/carb diet fattens like no other and creates addiction. After all we fatten cows on corn =sugar. The tests show also that a genetic switch is thrown and obesity/diabetes tendency will be embedded in the next generation. What is at the heart of our inactivity? Why do some kids stay active and others don't? What is different from the activity levels of kids 30 years ago and now - busing, TV sport etc. These are powerful questions which are not being looked at by the strategy.

The healthy living strategy sounds good on the surface but is essentially flawed in my mind. How? They did not think about the deep reasons. The process behind it - let's all get together and shout more loudly that we should eat better and take more exercise.

We can all say - we don't take enough exercise or we don't eat the right foods. We can all expose each other to more information about why we should change but without addressing the deep reasons why, we are wasting our time.

Government do this all the time - they confuse intellectual heavy lifting with consulting the community. If the Heart and Stroke folks were doing such a good job, why are deaths from this area on the rise? A lesson for us all.

If you see a problem and think that you will solve it by asking all the current "suspects" how to fix it - you will go no where. Why - because they are all inside the problem themselves and will only be able to see the the issues from the aspect of the problem

Eating and exercise are habits. These habits have a powerful grip on us and are formed when we are very young. We will find the answers when we look at how we as parents set the habits at home and at the habits set at school.

What do we habitually put on the table? Do we give toddlers lots of juice thinking that this is a good thing and not understanding that we are setting the palate. How big a role does pop play in our house? Do we all eat a lot of processed food especially breads, cakes and cookies? Do you eat margarine rather than butter? Is the TV the main baby sitting aide? How big a role is TV in our lives? Do we sit around at home and take little or no exercise? What is our habit for the kid's lunch box.? Does our local school have a deal with Coke and have a drink machine on the premises. What food is served at school. What exercise do our kids take as a matter of course at school?

I have hardly mentioned the big bugaboo - fat. The evidence is in. The addictive substance and the substance that is at the core of the problem is sugar/carbs. You don't believe me? Then correlate the rise in obesity with the rise in the consumption of sugar/carbs.

At the turn of the century the average American ate two pounds of sugar. Do you know what it is now? 160 pounds, and for many of us it's probably twice that. The human body didn't evolve to handle that kind of input. The pancreas works overtime to flood your system with insulin several times a day, every day. By the end of each day, it's completely exhausted and your bloodstream is still jacked up with dangerously elevated levels of sugar. Eventually your pancreas functionality is borderline to failure and you've got adult-onset diabetes. Eventually it fails for good and suddenly you're a diabetic.

A study about a year ago got a lot of press. It showed that a child who drank two cans of soda a day WILL be overweight. That's two cans of soda, not "lots of high fat foods."

At the turn of the century something like 2 or 3 percent of people were dying from heart attacks and stroke. What is it now? 70% and rising? You don't go from 2% to 70% with a slight decline in lifetime physical activity. But what about a typical lifetime sugar (carbohydrate) consumption increase of eight thousand percent?

What do YOU think the connection is?

My day at the dentist

Fri, 20 Jun 2003 00:58:17 GMT

I had a great morning having an implant inserted into my jaw and a wisdom tooth extracted at the same time. I had bananas and custard for dinner. I would not wish this on my worst enemy - it's also very expensive! Thank God for my mother whose birthday gift this is

Mon, 16 Jun 2003 00:05:16 GMT

Some Thoughts about Holistic Health and the Berlin Wall
Health insurance costs have been increasing by double-digits for three years running. This can be traced directly back to the cost of providing Western medical procedures, which are often compared to using a sledgehammer to kill a bug. Sledgehammers cost a lot if that's all you use.

Fewer employers are paying 100% of their employee's health insurance premiums.

More employees are rejecting health insurance through their employers, especially with young workers (NOTE: Link requires free registration).

Fewer people can be classified as "employees" and more people are self-employed, independent contractors, etc. who can make their own decisions about healthcare.

Doctors have been going on strike to protest the level of malpractice insurance premiums, which often exceed $200,000 per year. American doctor strikes have been quite rare until now. What is very interesting is that death rates tend to drop during doctor strikes!

Medical Savings Accounts (MSAs) are being used extensively by people who want more flexibility in spending their healthcare dollars, but still want the pre-tax benefits.

Wellness Savings Accounts (WSAs) are not yet reality, but once passed through Congress will provide a much greatly flexibility in the types of medical services that can be paid for using pre-tax savings.

Patient dissatisfaction with Western medicine is peaking.

Holistic health spending exceeds the out-of-pocket expenses that people pay for Western medicine.

Washington state passed a law in 1996 that states that a wide variety of holistic health services must be covered by every insurance company.

The major topic among Democratic presidential candidates is how to pay for the enormous burden of Western medical care.

Europe and Asia are far advanced beyond the U.S. in their incorporation of holistic health services into the mainstream.

America has the most expensive healthcare but its population is not the healthiest.

The cost of health insurance has caused a large percentage of Americans to go without it.

Can you hear the Berlin Wall of Western Medicine crashing down? [The Holistic Health Phreak]

More good sense

Mon, 16 Jun 2003 00:00:59 GMT

Big Guys Versus the Little Guys

It has been interesting for me changing my focus from large business consulting to holistic health, because these types of business are all small. I guess there are some large vitamin companies and some of the big hospital chains are dabbling in holistic health practices, but mostly it is one person businesses doing massage therapy, acupuncture, yoga instruction or whatever.

Some of the people I've talked to have expressed some fear about the ability of holistic health to make inroads given the huge presence of established Western medical institutions (hospitals, clinics, insurance companies, pharmaceuticals, government regulations, etc.). Maybe I'm just a Pollyanna optimist, but to me it looks like no problem at all.

Again, having come from the inside of large corporations and government departments, I can personally vouch that it takes f-o-r-e-v-e-r to get anything done inside a big organization. Large companies (and government more so) are mostly about power struggles, turf battles, politics, office romances and smoke breaks.

When we visualize big companies, we tend to think of those hard-driving, steely-eyed people at the top. And, indeed, those people are very intimidating. Only trouble is, they can't do much. Because directly below them in the hierarchy are people who are primarily concerned with a) how do I keep from losing this job, b) what does the boss want me to say and c) how can I get back at the person who dissed me last week. The ambitions of the corporation in the marketplace are not even on the list of concerns for 99% of the people in the organization.

Contrast this to the one, two or five person operation. It is possible to get everyone in a room and discuss what we need to do right now. What we want to grow towards. What our philosophy is towards our customers. It is almost effortless to manage something this small. But does it get done? Often, it does not, but that fact that it is so much easier to do makes these legions of small, holistic health service organizations much more powerful than any behemoth corporations or government agency. It's not even a contest. [The Holistic Health Phreak]

How true!!!!!

UFIT - Testamonial

Fri, 13 Jun 2003 19:20:06 GMT

The Tech.. Good Morning. Week 3 at the gym begins. No more pain, but all gain. My energy level has stopped suffering from my gym and UFit workouts, and I am starting to feel better than I have in years. Good Stuff. [The Tech. For Blogpeople.]

Onan - The Guy who spread the good seed upon the ground

Tue, 10 Jun 2003 21:02:45 GMT

Some of my readers - you know who you are - have complained about too many charts today "Pictoral Masturbation" was a term used

For you - One of my favourite pics from the Reverse Cowgirl

The Future - Getting Older 4 - Global Issue

Tue, 10 Jun 2003 11:03:58 GMT

This aging of the population is a global issue for developed nations. The one exception the USA. Here large scale immigration and high birthrates for immigrants will keep the age distribution more like a pyramid. But the US will become increasingly a Latin and Catholic country with a very large Asian segment. It will no longer be so focused on white and black.

As the developed nations creak with an aged population - who will pay the taxes? Who will do the work? Who will raise the next generation? We are going to have to change our ideas about aging and life. When you look at the grapgh, it may seem that we have lots of time. The system tips in 2020. But in fact we have only now to plan and to act as when the system tips, it will be too late

The Future - Getting Older - Drug Use

Tue, 10 Jun 2003 10:56:30 GMT

We are addicted to drugs. Drug use is the fastest growing aspect of healthcare spending. The users? Mainly seniors. Why? Because they expect to get a presrciption when they go to the doctor. Many are on so called lifestyle drugs to lower chloresterol, to help with hyper tension an so on. My mother in law is a typical she has no heart disease, she is 78 and yet she has a long series of medications aimed at preventing this type of issue.Why? Becuase she asks for them and the doctor prescribes to get her out of her office. Drug use will exceed all other health care spending areas in the next 10 years if unchecked.

The Future - Getting Older 2 - Healthcare costs

Tue, 10 Jun 2003 10:45:30 GMT

With no reform to the healthcare system and with no rethink about hwo we die - we will be overwhelemed.

This is the normal skew on health care spending as we age in the current system.

The Future - Getting Older 1 - The trend in Atlantic Canada

Tue, 10 Jun 2003 10:41:57 GMT

We all know that as a population we are getting older. We nod when we hear this and then get on with our lives. But I have found that when I see graphics about this trend, I start to see that we will live through a revolution. Never before in the history of any species has the population distribution been skewed this way. It will be worst in Notrth America in Canada and in Atlantic Canada where there is so little immigration.

Yet in a year when many Atalantic provinces go to the polls - do we hear a word about this issue? No In the next few posts I will show pou how this will effect us. Then judge whether this is an issue of importance or not.

Finding a Doctor? - Maybe we need a community group more

Wed, 04 Jun 2003 23:59:57 GMT

David Sifry is looking for help in finding a doctor

Today at the Formosa a group of PEI Bloggers talked about the power of groups of fellow sufferers to provide us with the best health information.

Here is an old link that I found back last year from Dr Marc Pierson - what it shows that our Doctors are the poorest source of information and that self help groups are the best.

Is there not a wonderful opportunity to use Social Software to meet this need?