Improving Health Outcomes in the US: Let’s Stop Relying on People Swimming Upstream

NEJM Catalyst commentary:

The United States ranks 36th in life expectancy despite spending more than any country on health care. This status cannot improve no matter how much we encourage individuals to try harder to engage in healthy behavior. Technology has, over time, created a modern world for which humans are maladapted, resulting in unhealthy behavior at scale. We are, in effect, constantly swimming upstream in order to be healthy and we need to systematically ask what it would take to make it easier for Americans to be healthier. Emerging technologies and behavioral science offer potential approaches to changing the environment in ways that make it easier for people to live healthier lives. Realizing this potential will require private sector leadership and complementary policy changes.

This is an interesting write-up. It calls for “re-shaping” the external environment and the use of technology to aid in that process. It says:

As each of us pursues health in this society, we are, in essence, constantly swimming upstream. The “choice architecture”–the manner in which choices are presented to us –creates currents that propel us toward unhealthy choices and away from healthy ones.

This is a confused write-up because that’s how the global capitalist systems are supposed to work. The choices are hoisted upon the individuals through combination of peer pressures, social effects of marketing and pushing towards the consumption led economy by eliminating the need for the alternatives (and creating convenience).

While the write up is complete balloney, there are some interesting nuggest around:

AI-driven algorithms and improved logistics could facilitate healthy meal planning, ingredient acquisition and meal prep, lowering the barriers to home-cooked meals and going well beyond the early promise shown by today’s prepared meal kits. Many prepared meal kits have high amounts of sodium or saturated fat and while motivated users can search for and find through an opt-in process healthier alternatives rather than putting the friction around finding the healthier choice for many consumers, alternatives that make the default (easy) choice the healthy choice likely lead to higher rates of consumption of healthy food.

I am not sure if the current trend towards “cloud kitchens” would eliminate the idea of cooking at home. Individuals have to be motivated to understand the consequences of the choices they make. If you make healthcare accessible, it would eliminate any chance of preventing the issues from cropping up in the first place.

We are in the early days of what some have called the Fourth Industrial Revolution, a revolution based on ubiquitous mobile and wearable devices and advancements in technologies such as artificial intelligence, robotics, the Internet of Things, virtual and augmented reality, 3-D printing, and materials science. There is, of course, great uncertainty about how these technologies will develop and how they will combine to create the products and services that will form the new normal of our everyday lives. But we know that they will have significant influence, and we have the opportunity to shape the nature of that influence if we choose.

Again- it is the hype- some communities may adopt the “smart living” but it doesn’t translate into healthier living (based on the above). We need to guard ourselves against the concentration of power (through data) in the hands of the big tech.

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