public health policy

Developing nations like India need food policies to ensure they don’t get sick before they get rich

Obesity is rising amidst the megatrends of urbanisation, globalisation, and industrialisation.

Improved human well-being is one of the modern era’s greatest triumphs. The age of plenty has also led to an unexpected global health crisis: two billion people are either overweight or obese. Developed countries have been especially susceptible to unhealthy weight gain, a trend that could be considered the price of abundance. However, developing countries are now facing a similar crisis.

Obesity rates have plateaued in high income countries but are accelerating elsewhere. The combined findings of UNICEF, the World Health Organisation and the World Bank showed that in 2016 Asia was home to half the world’s overweight children. One quarter were in Africa.

Residents of developing nation cities are increasingly susceptible to obesity, particularly amid the megatrends of urbanisation, globalisation, and industrialisation of food supply. According to India’s National Institute of Nutrition, over a quarter of urban-dwelling men and nearly half of women are overweight.

The majority of the world’s future urbanisation is projected to occur in developing countries, particularly in Asia and Africa. As rural dwellers move to urban areas, easy access to cheap and convenient processed foods lures them into unhealthy diets.

This crisis will test the political resolve of governments that have historically focused on ending hunger. These governments must understand that the factors making cities convenient and productive also make their residents prone to obesity. Intelligent, focused policies are needed to effectively manage this emerging crisis.

Urban lifestyles

Urbanites enjoy a variety of culinary options, ranging from aisles of processed goods in supermarkets to scores of short-order street vendors. Additionally, international fast food chains are flourishing in developing countries. This is shifting dietary habits away from healthier traditional fare and towards fried foods and sugary drinks.

The health risks of such diets are compounded by the sedentary lifestyles of urban dwellers. The most recent Indian nutrition survey found that city-dwelling men and women work an average of roughly eight hours a day. Most are engaged in sedentary office jobs. Only about one quarter exercise.

People’s leisure time is also being monopolised by passive diversions like television, movies, and video games in the growing number of households able to afford such technologies.

The alarming implication of these trends is that developing countries may become sick before they get rich. That sickness may, in turn, cripple health systems.

The yearly health care costs in Southeast Asia of obesity-related complications like diabetes and cardiovascular disease are already as high as $10 billion. Obesity among China’s younger generation could cost $724 billion in medical treatment by 2030. Such diseases are an added burden on countries already struggling to manage primary health care needs.

Policies related to taxation, urban design, education and awareness and the promotion of localised food systems may help control obesity at a lower cost than eventual medical treatment for an ageing and increasingly overweight population.

Direct interventions

Some governments have already experimented with direct interventions to control obesity, such as taxation on unhealthy foods and drinks. The US pioneered the soda tax movement. Thailand, Brunei, and Singapore have adopted similar measures. South Africa is likely to introduce a sugar tax beginning in April 2018.

Regulatory approaches have not stopped at taxation – or at sugar. In the United Kingdom, advertising rules prohibit the marketing of foods high in fat, salt and sugar to children younger than 16.

The city of Berkeley in California recognises that taxes alone are not enough to address obesity. Proceeds from the city’s sugar tax are used to support child nutrition and community health programmes. This underscores the importance of education and awareness.

There is also promise in broader-reaching initiatives. Urban design holds significant power to reshape lifestyle patterns and public health. Improving the attractiveness of public space, the “walkability” of neighbourhoods and the quality of cycling infrastructure can draw residents out of their cars and living rooms.

A recent study of urban neighbourhoods in Shanghai and Hangzhou found that middle-income residents living in less walkable neighbourhoods had significantly higher Body Mass Indices than both richer and poorer residents who lived in walkable neighbourhoods in urban China.

Finally, healthier lifestyles begin in grocery store aisles. Governments should encourage tighter connections between agricultural production systems, urban grocers and food vendors. Relationships with farmers in areas immediately adjacent to cities, in addition to the promotion of urban gardens, have been popular approaches in the US.

Such initiatives can also help urban residents better understand the mechanics of food sourcing. This raises awareness about the relationship between natural foods and healthy lifestyles. Even the preservation of culture around traditional foods can promote healthy alternatives.

Combining controls on unhealthy foods with policies that incentivise healthy eating and active lifestyles constitute a promising response to rising obesity rates. Addressing public health is a policy mandate for developing countries from both an economic and social point of view. To paraphrase the recent Global Nutrition Report, addressing obesity is a global imperative for releasing the brakes on development.

Asit K. Biswas, Distinguished Visiting Professor, Lee Kuan Yew School of Public Policy, National University of Singapore and Kris Hartley, Lecturer in City and Regional Planning, Cornell University.

This article first appeared on The Conversation.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.