Practice Health, Not Prevention

healthWhat is ‘health’?

What does it mean to be healthy? If I’m not sick, am I healthy? As long as I’m not sick, does it matter?

Health is a complex concept, it means different things depending on the context. Our health care system seems like an obvious starting point as I try to think about health and being healthy. The health care system of course includes health insurance plans, doctors, hospitals, drug prescriptions, and more. In this system I pay insurance premiums and copays, go to the doctor, get a blood test, take prescribed medications, etc. Is this what it means to care for my health?

Is my doctor caring for my health? Or is she primarily there to help me feel better when I get sick? Is taking a pill something I do for my health or for my disease?

Our health care system seems to be primarily focused on healing or managing poor health.

But if health care is mostly about healing disease, then I’m still stuck trying to understand what health is. Is it really just the state of not having any disease? If I don’t currently have any disease does that mean I am healthy and don’t need health care right now?

If I am healthy then how do I go about staying healthy? What about this thing the health care system calls ‘prevention’?

Prevention

prevention

With preventable chronic disease now consuming more than 3 of every 4 dollars spent on health care, there is a growing focus on prevention. New insurance claim codes, for example, allow health plans to pay for lifestyle change programs designed to help prevent pre-diabetes from developing into a full-blown type-2 diabetes diagnosis.

But health plans only spend about 3% on prevention. And while prevention seems like a logical solution to our growing chronic disease crisis, it doesn’t make much sense to expect a system that gets paid $3.3 trillion per year to treat disease to be responsible for implementing programs to prevent it. That’s kind of a ‘fox guarding the hen house’ problem.

And the reality is that prevention isn’t working anyway. Obesity rates are not going down. The total per capita cost of health care continues to increase. Type-2 diabetes is preventable, but the situation is getting worse not better. Some estimates suggest that 1 in 2 adults in the US are now either pre-diabetic or already have type-2 diabetes, many without even knowing it.

I believe that there is a an even more fundamental problem with the concept of prevention. Prevention is a life-long journey, not a 16-week billable health care encounter. But who wants to go through life ‘preventing’? That doesn’t sound like any fun.

Practice

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OK, so our health care system exists primarily to help me get better when I’m sick, but health is not just the lack of disease and attempts at prevention don’t seem to be working. Back to my original question: What is health?

Health may not really be a thing, or state that I can ever achieve. I can never really declare victory and claim that I made it, that “I am healthy!” No matter how much weight I have lost, or how good my lab results look, I’m never done. This brings me to the conclusion that health is something I do, not something I have.

Disease is something I have but health… health is something I do.

Health is about behavior, habits, lifestyle. Health is a way of living, not a goal or a destination. It is a practice.

Practice is a funky word too. I grew up thinking of practice in the context of little league and basketball practice. We had to practice if we wanted to play in the game at the end of the week and have a shot at winning. But let’s face it, practice sucked!

I’m not talking about that kind of practice. When I think of health as a practice, I’m talking about practice as a regular, habitual component of my life – a part of my identity, of who I am. So when looked at this way, when I claim that I am healthy, what I am saying is that I purposely live ‘healthily’, I practice health – not that my lab results and weight have reached certain thresholds.

This concept of practicing health – as opposed to preventing disease – is actually very profound, not just a new semantic. It starts with understanding and accepting that your identity is both determined by and reflected in your habits, and that you have the ability to purposely carve these identity-defining habits into your life. Habits are. That is just the way the brain works. Habits are the autopilot that run about 40% of your show. So you are either running on an autopilot programmed by people and circumstances you didn’t purposely choose or you are running on an autopilot that has been programmed on purpose, by you.

So stop trying to prevent disease and instead begin practicing health. Don’t worry so much about the outcome, focus on the practice. Eat on purpose, sleep on purpose, exercise on purpose, every day, make it a habit – practice health.

Maybe some day we will have a health practice system to complement our health care system. Employee-sponsored heatlh wellness benefit programs may be where this health practice concept starts. But if it is going to last, we can’t make the mistake that many critics of employee wellness programs are currently making and give up if we don’t see health care costs going down before the next earnings report. The goal is the practice, not who win’s the game on Saturday.

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Staying Engaged: How To Use Streaks and Weekly Goals

Establishing new behaviors that eventually become habits that can lead to a new identity or sense of self can be hard. Two techniques that have worked to help me stay engaged as I work towards creating new habits are streaks and weekly – as opposed to daily – goals.

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not wearing a Fitbit!

Just to be clear, a streak is just a number of consecutive times in a row that you have met a goal (I don’t want to get you arrested!)  The typical default step count goal in an activity tracking app like Fitbit for example is 10k steps per day, so a streak of 14 days would be 2 consecutive weeks of meeting the goal every day. Streaks are interesting to me because they leverage this cognitive bias that behavior researchers call “loss aversion”. Continue reading

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A Small But Significant Patient-Centered Example

Digital health solutions that facilitate patient engagement must put the patient in charge, not the physician. Outside of the clinic, where health happens, in the day-in, day-out lives of people, we have to let the patient take ownership of and decide how they are going to engage and be “compliant” (I hate that word).

Here’s a simple example:

I’m working with a start-up who is shipping a remote patient monitoring and engagement tool. One feature of the experience enables patients who opt-in to be able to communicate with the clinic by receiving text or smart phone push notifications from the clinic with test results and instructions to modify medication dosage regimens. This an on-going, monthly process for patients on this specific long-term therapy.

A physician who recently started using the tool wanted to work through his list of new test please_do_not_disturb_signresults in the very early morning hours before he went into the office for the day – but didn’t want to bother the patients with notification messages before 9am. So, he requested a simple feature to allow him to delay the outbound patient notification a number of hours, depending on when he was working through the list. This way he knows that all of his messages will be received by his patients at 9am or later.

On the surface that makes sense, and sounds very empathetic – let’s give the physician the ability to adjust his workflow to best work with his schedule while not bothering the patient at odd hours of the morning. Providing the physician this lever to make that work sounds kind of patient-centered, right? Continue reading

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From Tiny Habits to Big Habits – My Five

On my journey to learning some of the neuroscience and behavior science research behind these things we call “habits”, I decided to put the theory to a test and see if I could turn what I considered to be a big, hard to achieve behavior – going to the gym every day – into a habit. Along the way, I found it helpful to distill what I was learning into a few key mantras that would be easy to remember and keep in mind. So here they are, the 5 key principles I used to turn exercise into a habit – I call them “My Five” (warning, I’m an engineer, not a poet!).

1. Not a Freak, Predictably Unique
NotAFreak

It all starts with the realization that there is a high probability that my brain is extraordinarily average and that most of this research I was learning about is actually applicable to me too. Leverage the science, don’t fight it.

2. No Pain, All Gain

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Do not make the behavior you want to turn into a habit a willpower challenge – which I define as a task that is painful today but will pay off in the future. Instead, completely forget about any future goals or rewards and find a way to make it immediately rewarding on it’s own.

3. Crave The Wave

wave01Consciously cultivate a craving for the behavior. Take time every day to pause and look forward to the next chance to do it again.

 

 

4. Get It Done With The Sun

GetItDoneWithTheSun

Do it in the morning, before the day gets “started”. The first hours of the morning are the only truly predictable part of the entire day, so leverage that time to create new big, hard habits.

 

5. Lose the Virtue, It Will Hurt You

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It’s just a habit – avoid the dangers of what psychologists call “moral licensing” and don’t brag about it or give yourself any extra credit for getting it done every day.  Just do it and get on with your day.

 

 

Those are my five guiding principles for creating big, hard habits. (I warned you… I’m not a poet, but the rhyming thing makes these very easy for me to remember and keep in mind on a daily basis.) Either stop reading now, or get comfortable, because I’ve got a whole bunch more to say on the topic. Continue reading

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Big Data or Tiny Habits?

To repeat the oft-quoted words of Aristotle: “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

I believe that wearable activity tracking devices can be powerful habit transformation tools and I’m frustrated to see instead the huge emphasis that is being placed on the hopes of the “big data” insights to be gleaned from their use.

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Continue reading

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Step To Give Results: Fun, Engaging, and Rewarding

The Step To Give experiment was fun, engaging, and for me personally it was surprisingly rewarding.  Big smile, very big.

smile

Nine of us paid $10 each and worked together as a team for 21 days to meet the team total step count and therefore make a donation to the Alliance For a Healthier Generation – to help fight childhood obesity.

The total team commitment added up to just over 1.5 million steps and we ended up walking more than 1.8 million steps. That’s about 900 miles!! (read more about the mechanics of the Quest here, and have a look at the team tracking spreadsheet that I updated 3-4 times per day here) Continue reading

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Step To Give: An Activity Tracker Engagement Experiment

In a couple previous posts  (here and here) I wrote about some ideas for how fitness trackers might leverage peer pressure and intrinsic rewards to keep people engaged with their shiny new wearable toy once the shiny new part wears off (no Misfit Shine pun intended!). In summary, the idea is to form small teams that work closely together on a step quest to meet a team goal. Meeting the team goal for the quest results in a donation being made to a prosocial cause.

To take these ideas a step further (sorry), I am going to run an experimental step quest with a team of about 10 Fitbit users called Step To Give.

Step To Give – The Mechanics and Rules

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The Step Quest experiment is going to work like this: Continue reading

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