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BODIES &�BUILDINGS NYU ITP LECTURE COURSE SPRING 2013
CLASS 2: FEBRUARY 4, 2013
JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM
LEVERAGE POINTS Class assignment for 2/4/2013
Mandatory! Read ALL OF Donella Meadows:
Leverage Points: Places to Intervene in a System
Take leverage points 9, 8, 7.
Write a 1 page or 500-6000 word essay on the following topic:
How do mobile apps try to affect leverage points 9, 8, and 7.
9) The length of delays, relative to the rate of system change
8) The strength of negative feedback loops, relative to impacts they are trying to correct against
7) The gain around driving positive feedback loops
Give one example and explain how the app is or is not designed to affect each of these leverage points. How effective do you think this app will be at changing behavior?
You will be asked to present your work, so practice rehearsing your in class presentation at least two times.
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PLACES TO INTERVENE IN A SYSTEM: 12. Constants, parameters, numbers (subsidies, taxes, standards)
11. The sizes of buffers and other stabilizing stocks, relative to their flows
10. The structure of material stocks and flows (transport networks, population age structures)
9. Length of delays, relative to the rate of system change
8. The strength of negative feedback loops, relative to the impacts they are trying to correct against
7. The gain around driving positive feedback loops
6. The structure of information flows (who does and does not have access to what kinds of information)
5. The rules of the system (such as incentives, punishments, constraints)
4. The power to add, change, evolve, or self-organize system structure
3. The goals of the system
2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises
1. The power to transcend paradigms
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BODIES IN THE NEWS LabDoor Launches: lets users search for their dietary supplements and view grades reflecting their clinical efficacy and ingredient safety.
New HIPAA rules finalized: When a patient is required by a provider to request records or documents in writing, the request may be made electronically.
In a video produced for the release of Bill Gates's 2013 Annual Letter, Swedish academic Hans Rosling explains why common notions of developing vs. developed countries are no longer clear-cut.
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BODIES: THE OBESEITY EPIDEMIC
BODIES & BUILDINGS
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BODIES + We have made huge strides in life expectancy, but we have reached limits of growth.
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NATIONAL OBESITY CRISIS
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US OBESITY GROWTH RATE
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Today’s children may well be the first generation of Americans whose life expectancy will be shorter than that of their parents.
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OBESITY TRENDS
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Data from 3,139 counties in the U.S. Quintiles are cohorts of counties ranked by the percentage of people living with poverty.
Levine J A Diabetes 2011;60:2667-2668
Copyright © 2011 American Diabetes Association, Inc.
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DIGITAL DIVIDE + DIABETES
Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access.
Urmimala Sarkar, Andrew J Karter, Jennifer Y Liu, et al.
J Am Med Inform Assoc 2011 18: 318-321 originally published online January 24, 2011.
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GLOBAL OBESITY PANDEMIC “GLOBESITY”
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GLOBAL OBESITY: TRENDS, RISK FACTORS AND POLICY IMPLICATIONS. VASANTI S. MALIK, WALTER C. WILLETT & FRANK B. HU. NATURE REVIEWS ENDOCRINOLOGY 9, 13-27 (JANUARY 2013)
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Figure 1 Global trends in the prevalence of obesity among women and men in 1980 and 2008 from select regions of the world
Malik, V. S. et al. (2012) Global obesity: trends, risk factors and policy implications Nat. Rev. Endocrinol. doi:10.1038/nrendo.2012.199
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Women
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Men
OBESITY + GLOBALIZATION
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THINKING IN CIRCLES ABOUT OBESITY
APPLYING SYSTEMS THINKING TO WEIGHT MANAGEMENT.
TAREK K. A. HABI
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HOW THE PROBLEM SNEAKED UP ON US
As the upward and outward trend in the population’s weight and waistline accelerated in the late 1980s and 1990s, most public health experts failed to perceive the escalating threat.
• Unlike communicable diseases, no immediate symptoms.
• Initially only affected a few people.
• The science establishing links between diet, weight and health were just beginning.
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HOW MANY CAUSES CAN WE COUNT?
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BUCKET THEORY OF MIND
• Minds seen as containers – Karl Popper.
• Public understanding is viewed as a function of how much scientific facts are known.
• How many scientific facts public minds contain.
• Irony: Americans know more about food and nutrition than in any time in their history, but they are gaining more weight.
• “Knowledge (in the bucket) without the requisite decision-making skills will produce little change.
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THE LEVERAGE (OR THE IMPEDIMENT) IS WITH THE PEOPLE
• In the US, most obese individuals attempting to lose weight do so themselves, without seeking professional help.
• Weight has been seen as an individual, personal problem.
• The wellness movement is rooted in the concept of personal control.
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WE ASSUME MORE CONTROL THAN ACTUALLY EXISTS
• Obesity is a complex multi-factorial disease involving genetics, physiology, and biochemistry, as well as environmental, psychosocial, and cultural factors.
• In managing our health – and our bodies – we are decision makers who are managing a truly complex and dynamic system: the human body.
• Living systems do not come with an operator’s manual. It requires skills to see through complexity to the underlying structures generating a complex situation or problematic behavior.
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IT’S SO EASY
CALORIES IN. CALORIES OUT.
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MORE COMPLEX THAN THAT
• Body’s homeostatic process- adaptive (and defensive) mechanisms that continuously aim to maintain the body’s internal stability.
• Weightloss is not linear, but curvilinear.
• Unrealistic optimism causes us to ignore legitimate risks.
• Failure to learn from failure. Learning has not occurred.
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PHYSIOLOGICAL ASYMMETRY
• Humans are wired to compensate for caloric dilution but not the reverse.
• Asymmetry in energy expenditure- basal metabolism.
• Asymmetry in energy storage- when body fat is shed during weight loss, the size, but not the number, of fat cells dwindles.
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SINGLE LOOP LEARNING
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Consequences
Feedback Decisions, Actions
Single loop
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SINGLE LOOP DIETING
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SINGLE LOOP LEARNING
• Often we find ways to move closer to our desired state without changing our mental model.
• Learning to use life’s raw experiences to adjust our entrenched worldviews is hard and, therefore, uncommon.
• Experience, after all, provides only data, the raw ingredients for learning, not knowledge.
• Single loop: we learn to tweak our decisions without altering our mental models or their associated decision rules.
• (A thermostat that sense when it is too hot or cold).
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SINGLE LOOP DIETING
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WHAT IS TO BE DONE
CHALLENGE INGRAINED ASSUMPTIONS
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DOUBLE LOOP LEARNING
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Consequences
Feedback
Mental Models Of Real World
Decision Rules, Strategies
Decisions, Actions
Single loop
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DOUBLE LOOP LEARNING
• Learning that occurs when we use the feedback information to enhance our fundamental understanding of the decision task.
• Learning is discovery of mental maps and decision rules that are better aligned with the decision task at hand.
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SHIFT IN PUBLIC POLICY
• From: stuff buckets with nutritional guidelines/scare into good health
• To: challenge people’s deeply ingrained assumptions. Provide them with the conceptual skills to JUMP.
• From: attention on the separate mechanisms of human weight and energy regulation.
• To: the hole bioenergetics systems as an integrated operating system.
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FRAGMENTIC ANALYSIS LENS
• Nutrition out of the context of lifestyle
• Biology out of the context of behavior
• Behavior out of the context of environment
“The performance of any system (whether it is an oil refinery, an economy, or the human body) obviously depends on the performance of its parts, but a system’s performance is never equal to the sum of the actions of its parts taken separately.
Rather it is a function of their interactions.”
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SHIFT IN CULTURAL UNDESTANDING
• From: solely individual interventions. A sole focus on the obese person and how to help them gain control.
• To: Why is society obese. How can we help society.
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SHIFT HEALTHCARE PRACTICE
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NETWORKED MEDICINE
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ASSIGNMENT: FEBRUARY 11
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February 4, 2013
READING Read: Networked Medicine: From m Obesity to the “Diseasome”. Editorial by Albert-László Barabási, Ph.D. NEJM. July 26, 2007.
Optional:
Deeper Reading:
Original Study by Christakis and Fowler: The Spread of Obesity in a Large Social Network over 32 Years. NEJM. July 26, 2007.
Critique of this study: Lyons.
The Spread of Evidence-Poor Medicine via Flawed Social-Network Analysis. Statistics, Politics, and Policy: (2011) Vol. 2 : Iss. 1, Article 2. Last revised 5 May 2011
Watch: Catherine Kerr on Cortical Measures in Mindfulness Meditation at Quantified Self.
Personal account of Weight Watchers by Laura Beck at Jezebel.
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ASSIGMENT When developing ideas and concepts for our student projects, and future projects, business ideas, and save-the-world ideas, we often start by designing for ourselves.
For this assignment, research a part of the world at a local level (city, state, province, county) that has a problem with obesity. The only requirement: pick somewhere that you have never been.
In a one page essay, describe the social, cultural, technological, economic, and other conditions of this region that may be contributing to a growth in the prevalence of obesity. You may choose to write a non-fiction account or take this as a creative writing assignment – imagining a first person day-in-the-life account of what it feels like to live here.
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LINKS AND PRESENTATION
Today’s class presentation is available
http://jenvandermeer.com/2013/02/bodies-buildings-class-2-february-4/
And Links from this presentation are available here at Annotary.
https://annotary.com/collections/9149/bodies-and-buildings-class-2-nyu-itp
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