The Joep Lange Insitute organized a lecture on Healthy Living as Lifesaving Medicine in the Balie in Amsterdam. Experts from different fields were invited in order to think of possible solutions and to find out how technological innovations can help us lead healthier lives. Present were behavioral economist Dan Ariely, obesity specialist Jaap Seidell, Head of Epidemiology GGD Amsterdam Arnoud Verhoeff, the manager of Sustainable Retailing at Albert Heijn Johan de Visser and deputy director of Question Mark Marit Metz.
The case is clear: lifestyle changes can prevent chronic diseases such as heart disease, stroke and cancer. It saves lives and cuts healthcare costs. Yet, despite this focus, we are still looking for an effective strategy. What are the main dilemmas and where can we start? Here are the 5 main takeaways of the lecture.
No alternative – “Investing in prevention is the only affordable scenario we have for healthcare,” says Jaap Seidell. He explains that half of the Dutch population deals with a chronic illness and this won’t get better. In 2030, 20% of Dutch GDP will go into healthcare costs. According to Seidell “we can no longer afford social security and education in the future because of the high costs of healthcare.”
“Investing in prevention is the only affordable scenario we have for healthcare” – Prof. Jaap Seidell
It is not just a problem of the affluent societies: 80% percent of the people dying of non-communicable diseases live in low and middle income countries. “We will live in a completely different world because of our healthcare problems,” explains Seidell. Can we postpone or prevent these diseases? According to the WHO it is estimated that 80% or more of all these premature heart disease, stroke and diabetes cases can be prevented. Seidell: “By simple interventions in high risk groups you can postpone or prevent the risk of type that is very cost effective, with at least ten years. If we change people’s ways of living into healthier habits you can reduce almost all cases.”
World of temptation – creating healthier habits sounds easier than it actually is. Jaap Seidell: “It is not lack of control or eating behavior, it is not laziness and poor choices that people or children make it is the environment that they grow up in.” According to Seidell we live in an obese society, that includes also slums in the major cities in low income countries. Dan Ariely agrees “As a society we have been really good in tempting people. We give people free access to donuts and what do we think would happen? It is like giving people information that says “walk in this field of donuts but don’t eat them.” It is almost inhumane.”
Ariely worries that interventions are now focused on giving people information. Ariely: “Information alone does very little. In our history of human social changes came from something else: villainizing, fines, taxes, social acceptance” He mentions the case of smoking: “the biggest effect came from the term secondhand smoke. We villainized smokers. After this happened we could ban smokers from all different places.” For this reason, Ariely thinks for an effective preventive model we need to become more interventionist and to start become more opinionated. Ariely: “We need to penetrate people’s homes, we need to change people’s environment. Without those environmental changes I don’t think we are going to get much further.”
How much free will? – “How paternalistic are we willing to be?” Ariely says. He explains that it is not an easy discussion, but definitely a necessary one. Taking in account that people make short-term decisions instead of thinking about what is good for them in the long run, in the current environment people are constantly tempted to misbehave. Ariely: “How much free will do we want to allow people to have? Because the more free will we allow people to have, the more tempted they will be.”
Jaap Seidell: “We should set standards for food environments for different settings: at schools, hospitals and government buildings.” He referred to the work that the City of Amsterdam is doing at promoting healthy choices at schools. Arnoud Verhoeff explained that healthy weight is a collective responsibility and the healthy choice should be the easiest choice. For this reason, as part of the Healthy Weight program, together with schools the City of Amsterdam made drinking of water, instead of sodas, the norm at schools, with a significant impact.
What about the private sector? How much can we expect from supermarkets like Albert Heijn? Even though, the company is collaborating in the Amsterdam Healthy Weight Program, free choice of the customer is still one of the main drivers. “We believe the customers are in control. We cannot force a healthy lifestyle, but we can give inspiration,” explains Johan de Visser, who listed numerous ways how his company is inspiring people to eat healthier, by for instance marketing healthy products first and offering ready to use vegetable snacks and pre-packaged ingredients for healthy meals. Ariely, however, believes they could do more in reducing the complexity of choices: “In the supermarket people make around 70 choices. Chances that they make 70 healthy choices is very low.” He suggested trying an experiment with a supermarket where people can take a green healthy lane, with only healthy products or a red one, with the unhealthy stuff. Another suggestion Ariely gives, is providing info on how many minutes you need to run to burn the calories you are about to eat. The effect of this was tested very positive. Currently, the way we give information on packages about calories and sugar amounts hardly have any effect. Ariely suggested Dan suggested this calorie-running principle to the Minister of Health in Israel but he was afraid he would be laughed at if he would implement that. Instead, to reduce the complexity of choices they have now started to label all healthy products with a green label and the unhealthy products with a red label. The effect they see already is that the industry is adjusting the ingredients to get more products with green labels in the stores.
“We believe the customers are in control. We cannot force a healthy lifestyle, but we can give inspiration.” – Johan de Visser
Break points – “We need to think of a person as a whole. Not just as patient,” explains Ariely. “As patients they know what to do. But it just that life can sometimes be too much, for example due to financial stress. At those so-called break points, the answer is cookies.” Ariely gave the case of a diabetic: “Life of patients with diabetes is highly regulated, they need to take their medicine on time, exercise enough, eat at set times and eat healthy.” According to Ariely a break point is when people get to this level that they say “fuck it. I cannot handle it anymore,” and what happens: fried food, chocolate, high calories, dessert. Break points are according to Ariely the most important cause of too high glucose levels that causes complications in the long run. Recognizing these break point on time and helping people get past them is essential for long term effects.
Seidell sees stress also as the main barrier for healthy behavior, affecting mainly the poor. The poor experience more chronic stress, on food insecurity, job insecurity and financial insecurity. . “What do we know about chronic stress. People cannot plan ahead and find it difficult to make long term decisions. Helping them with stress relief is one of the clear first things that we need to do. This reduces health inequalities.”
Technology – “I believe in technology. Who doesn’t? Otherwise we need 10 million doctors to treat all chronic patients in the future,” says Ariely. He gave several examples of games and apps that support people in making better choices. Sometimes in quite a paternalistic way, like a turtle app for patients recovering from a severe operation, that eats other popular apps on your phone if they don’t follow the treatment protocol.
“I believe in technology. Who doesn’t? Otherwise we need 10 million doctors to treat all chronic patients in the future” – Prof. Dan Ariely
“The technology is there. How can we make it fun? Using gamification, where you earn credits for reducing sugar and fat intakes,” says Marit Metz, who presented an app informs people on how sustainable and healthy products in the supermarkets are. “We have the data, we enrich data, we put it out there and we put it out there in rankings. We share this data with consumers, with the media and with companies. And what we see now happening is that companies are willing to change their products to score higher.”
You can watch the entire lecture below.