“Thinking Slow”About Fast Food

By varlene guischard | Blog, Caribbean Behaviour Change Network | No Comments

“Thinking Slow”About Fast Food

Written by: Ayodhya Ouditt Updated: Jan, 2020 3 min read

A friend of mine recently got some good news regarding a job and wanted to celebrate, so we went down to the strip of food stalls near Grand Bazaar for some street food and then later headed to a bar for a drink.

While I’m certainly not trying to come across as one of those people who complains about everything, it’s also a requirement that a designer be ready to exercise critical thinking at all times. In particular, if one’s concern is social good, and human, animal and environmental wellbeing, paying attention to one’s surroundings is vital.

So with that said it’s always disheartening to me when we go out to lime and I see parents feeding their children cheese-steaks and ‘hoagies’ drowned in sauces, and watering them with coke, pepsi, or some other soft drink. These all come in styrofoam boxes and plastic bottles, which (if one is lucky) are thrown into a bin, but far too often end up in a canal.

This is a bleak situation, for the animals consumed and the human consumers, as well as for the urban and natural environment. But we see this — and even participate in it — everyday, to the point of numbness.

As I heard the lady behind me call to the gyro man for “more mayonnaise” on her burger, I wondered… “What is the reason for this? Why did she feel like she needed more?”

While there are of course many different factors leading to our poor health decisions, if I had to pick just one thing, I thought, it would have to be an overdose of System 1 Thinking, and a deficiency of System 2 Thinking.

Systems 1 and 2 refer to different paradigms of thinking, both of which operate in very different ways. I first saw the terms used in behavioural economist Daniel Kahneman’s “Thinking Fast and Slow”, but they were actually coined by psychologists Keith Stanovich and Richard West. In Kahneman’s tome, he writes about them like characters in a drama, outlining in particular the ways in which System 1, which comprises our brain’s most ancient survival mechanisms, often betrays us in modern life. Within the title, ‘thinking fast’ refers to System 1, and ‘thinking slow(ly)’ refers to System 2.

“System 1 operates automatically and quickly, with little or no effort and no sense of voluntary control.

System 2 allocates attention to the effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration.”

So System 1 handles things like detecting hostility in the voice of another, driving a car on an empty road, and of course thirsting after those calorie dense burgers, double-meat gyros, and sugary soft drinks.

System 2 on the other hand allows us to consider that the above mentioned person might have just been stressed, allows us to drive on a crowded road, and enables us to think about making a healthier dinner choice.

The problem is that System 1 works faster, and System 2 requires more mental resources. So if we’re pressed for time, stressed, or just not making a conscious effort to think and act critically, we’re going to be much more susceptible to our instincts when making decisions.

And that’s why that lady asked for more mayonnaise on her burger. It’s simply faster and easier for her brain to think about mayo tasting good. But perhaps if this information were more widely available, and we all understood that this is how we make decisions, we would all be able to double-check our first instincts.

It’s very important for us to think this way, using metacognition — thinking about one’s own thoughts — to reflect on our choices. If we know that we’re susceptible to System 1 thinking all day long, we can engineer better ways around it, by reducing the cognitive load in our daily lives.

When public health campaigns fail, usually it’s because they human beings are expected to absorb information rationally, then execute the desired behaviour perfectly. But we all know that this simply isn’t our nature. You can’t outrun System 1. You can only work around it. That’s why policymakers, public health experts, and designers for behaviour change need to think slow, and not fast, when it comes to improving population health.

The Encediscene: Health Choices in the Time of Your Life

By varlene guischard | Blog, Caribbean Behaviour Change Network | No Comments

The Encediscene: Health Choices in the Time of Your Life

Written by: Steve Ouditt Updated: Jan, 2020 3 min read

In July 2017 our team at Vessel downloaded and read the ‘National Strategic Plan for the prevention and Control of Non Communicable Diseases: Trinidad and Tobago 2017 – 2021’, from the Ministry of Health’s website. We studied this plan from cover to cover, to understand how people are coping with NCDs [non communicable diseases] and to see what’s in store for us. We were alarmed at the danger we’re in.

NCDs are killing us and soaking up billions of dollars every year. Take a look at these stats published in the Strategic Plan. For 2015 – 62% of deaths annually were from NCDs; 25% died from heart disease; 14% died from diabetes; 13% died from cancer and 10% died from cerebrovascular disease. There are approximately 39,400 undiagnosed cases of diabetes. 50% of diabetes deaths occur before the age of 65. There are over 500 amputations a year. On page 5 of the report it tells us that there is an increase in NCD onset in people under 45 years of age. Also, compared to other Caribbean countries, our life expectancy in Trinidad and Tobago is way down the list at number 19 out of 21. We’re just above Guyana, with Haiti last.

These stats on paper are terrible as is, but in the lives of real humans living with NCDs, the situation is unbearable. Even if you’re rich and powerful in Trinidad and Tobago, but have a history of making bad health choices, your money and power won’t save you. It might buy you a little more time, but that’s all.

For many years in rich Trinidad and Tobago, lavish living set the scene that made it easy for people to be extravagant and careless about health choices. There were plenty easy opportunities for rich and poor to become lazier; fatter; greedier; to party harder, and to drive big pick-ups and SUVs. It became easy too, to set such bad lifestyle examples for their children. Right now Caribbean Public Health Agency [CARPHA] has a document on its website on NCDs and childhood obesity, with the hopeful title, ‘Safeguarding our Future Development’. People need to read this.

Our National Strategic Plan for NCDs says that the economic burden on Trinidad and Tobago, from diabetes, cancer and hypertension is about TT$8.7 billion annually. That’s more than US$ one billion per year, and almost one billion Euro a year. To put things into perspective, compared to our annual NCD spend, the rapper Drake’s worth looks like real small money, at a paltry $US100 million. Any state of our size that spends TT$8.7 billion every year on NCDs must admit that it’s losing the battle.

Here is an excerpt from page 14 of the document “Investment in prevention interventions are urgently needed to decrease the incidence and reduce the substantial economic burden. Diabetes and hypertension are due to highly modifiable behavioural factors and prevention interventions can reap huge benefits”.

Another way to say this, and how Vessel interpreted it, is like this, “We urgently need interventions to prevent these NCDs and save billions of dollars. We believe if people change their behaviour and learn better health habits, this will go a long way in reducing diabetes and hypertension.”

It’s not rocket science to understand. To put it quite simply if the state and all health agencies created brilliant interventions to prevent people from smoking too much, from abusing alcohol, from eating unhealthily, from getting obese, from raising their cholesterol and blood sugar, they would save lives and money.

Right now we’re living in the era that scientists refer to as the Anthropocene. It’s the age of heavy human domination and impact on all our ecosystems. This human domination of everything has made it easy and convenient to make bad health choices in all aspects of our lives. We’re now facing the massive and dangerous backlash that we at Vessel have named the Encediscene [NCDscene]. We imagine we’re living in the era of the NCD. Just read the plan.

Vessel has designed a behaviour change interactive exhibition tentatively titled ‘The Encediscene: Health Choices in the Time of Your Life.’ In upcoming posts we’ll be put up some drawings of our idea. Look out for them.

Steve.

The Backbone of Design for Health Behaviour Change

By varlene guischard | Blog, Caribbean Behaviour Change Network | No Comments

The Backbone of Design for Health Behaviour Change

Written by: Steve Ouditt Updated: Jan, 2020 2 min read

Designers for health behaviour change should learn extensively about the Social Determinants of Health as it illustrates how much our health is shaped by people, places, things, services, organizations, systems, law and lawmakers. One of the best sources of information on the Social Determinants of Health is the World Health Organization – http://www.who.int/social_determinants/en/.

Here is how they define it, “The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”

Social determinants include: the food we eat; our levels of education; the quality of our family life; the nature of our jobs; how we get to and from work everyday; the communities we live in; the good and bad policies of the state and much more. In this social gradient of health, if we take a microscope to any of these areas we’d see people of all walks of life creating all sorts of systems and structures to make things fit nicely together. Take another microscope and we’d also see people failing to make things fit, or ‘make ends meet.’

Living inside this network of systems, it’s impossible to find a single factor that, if engineered well, will make everything work in perfect harmony. There is no perfect starting point for health improvement. This headache gets worse especially for those sliding down the social gradient in health. In short, experts define the social gradient in health as having a top and a bottom, where you can move up or down; something like a ladder propping against a wall but depending on the situation, the ladder might be raised higher or lowered somewhat flatter. Often it’s not one’s own choice to move up or down; this movement is shaped by the social determinants. At the top of the ladder are those, who, being in better socioeconomic standing will be in better health than those at the bottom, whose socioeconomic standing and health are both poor. The majority of the world’s population are trying to move up the social gradient of health.

That is our world. It’s stratified and unequal. Some people are born into wealth and some into poverty. Some are born into violence and some into peace. Some get breaks that make things work and some don’t. Some Governments care and some don’t. We never all start from the same place. Everyone in the world is subject to a unique set of social determinants to their health. Those of us who want to design behaviour change interventions must start by understanding this. At every turn in life we have to remind ourselves that there is a health information seeker, and a health care worker, living inside us all.

On page 3 of ‘The Health Gap: The Challenge of an Unequal World’, Sir Michael Marmot writes, “Were we going to tell the woman in Psychiatry Outpatients that she should stop smoking and, as soon as her husband stopped beating her, she should make sure that he and she had five fruit and vegetables a day?……. Were we going to tell the immigrant with a marginal, lonely existence to stop eating fish and chips and take out membership in a gym? ……….And for those who assert that health is a matter of personal responsibility, should we tell the depressed woman pull her socks up and sort herself out?”

Conscientious designers who work for better population health know these challenges. They know that they can’t simply apply design methods to design away these problems, nor would they be so insensitive and flippant as to think these problems can be solved with an ad campaign. Designers for health behaviour change are trained to expect such dire situations. That ‘s why their curriculum must be grounded on a solid programme of social justice. It is the pillar upon which design for health behaviour change should be built. If this is not the backbone of their programme and belief system, they will be found out early by the shallowness of their work and the institutions they attend. They will never be able to bluff it.

The photos in this blog post are book-covers from books in Vessel’s library. This post could not have been written without studying and comparing passages in these excellent texts.

“How To Thrive In The Next Economy”, and the [Social Determinants of Health]

By varlene guischard | Blog, Caribbean Behaviour Change Network | No Comments

“How To Thrive In The Next Economy”, and the [Social Determinants of Health]

Written by: Ayodhya Ouditt Jan, 2020 2 min read

In John Thackara’s book, “How To Thrive In The Next Economy”, he takes a simple and clear look at how all over the world, small scale community interventions might offer solutions to some of the world’s major social and environmental problems. Thackara, a writer and advisor on matters of sustainability and ecological design, has a simple thesis: our planet’s biggest problems are the result of a flawed model — the ideal of the economy of infinite growth. And to be more blunt, it’s flawed because infinite resource consumption is impossible on a planet of finite resources.

But the book doesn’t focus on the disconnect between the human economy and the rest of nature — what Karl Marx called the “metabolic rift”. Rather, Thackara identifies solutions from all over the world, with the overarching narrative that these are largely local, community oriented, and technologically ‘light’ or ‘noninvasive’. These are presented as clear and concise case studies, drawn from his lifetime of travel and environmental observation.

Each chapter is based on another touchpoint of human civilisation, or to put it more honestly, a ‘need’, (water, shelter, transportation, energy, etc.) for which, examples are given.

For instance in Chapter 3, “Waterkeeping”, Thackara describes water safeguarding techniques such as “Participatory Groundwater Management”, a community driven model in which drought-affected smallholders like the farmers in Andra Pradesh, India, each monitor various watersheds on a daily basis, sharing the information and of course the water as well. Thackara adds — “Before the new system was introduced, farmers had to rely on data provided by so-called ’input dealers’ — fertilizer, seed, and pesticide companies; these sources tended to downplay the huge wealth of grounded knowledge”

The simple and clear structure of these stories is something I have always enjoyed. But in reading them over more recently, in the context of Vessel’s work, I’ve discovered a brilliant layer of subtext which I can only now appreciate. You see, in many ways, the issues Thackara identifies can be seen as the social determinants of health, or rather, as their precursors.

While there is no single definition of the social determinants of health, they can be generally understood as the economic and social factors that influence individual and group health in different populations. The list of determinants is similarly fluid, with different organisations and policy documents paying attention to different features of their respective societies. For the sake of a simple example, in 2003 the World Health Organisation, Europe included the following as determinants —

The social gradient
Stress
Early life
Social exclusion
Work
Unemployment
Social support
Addiction
Food
Transport

That the ten chapters of Thackara’s book and the social determinants of health seem so compatible, is in my estimation no accident. It’s easy to see for instance how issues like pollination, deforestation, and climate change do in fact bear heavily on food security, work, and migration, which in turn lead us to consider more obvious issues like unemployment, social support, exclusion, and addiction.

I like to think about Thackara’s globally ‘crowdsourced’ solutions to environmental problems like deforestation and water potability as addressing the environmental determinants of the social determinants of health. The solutions he describes are therefore not isolated environmental interventions, but measures that we could take to insure our societies themselves, against the burden of disease brought on by our global economy’s metabolic rift with nature.