By McGill Reporter Staff
Addressing the World Health Summit in Berlin in October, Professor Laurette Dubé warned that the current dominant approach to combating an exploding global epidemic of diabetes and heart disease is too narrowly focused to succeed.
Dubé, a professor of marketing in the Desautels Faculty of Management and a prominent obesity researcher, argued that in place of the current approach, which depends heavily on medical treatment, government regulation and education, the world must shift to a behavior-change approach that enlists deep collaboration from the commercial sector, neuroscience and grass-roots organizations. “The impact of health policies is limited,” Dubé told the Summit, “when the consideration of health impact comes as an afterthought to policies that have been separately determined for the economy, industry and agriculture, and when they don’t account for how people make decisions about their eating and other behaviors.”
Dubé was speaking as a lead presenter at the World Health Summit panel on tackling so-called “non-communicable diseases” (NCDs), which include heart disease and diabetes, and which are frequently triggered and exacerbated by poor nutrition, smoking and drinking, among other factors. Obesity in particular is of increasing concern, as countries all around the world, including in developing regions where hunger is still a threat, experience rapidly rising obesity rates that are already as high as 30 per cent, accompanied by skyrocketing NCD rates that are wreaking havoc with mortality, quality of life, productivity and healthcare costs. For that reason, attention in the global health community has been increasingly shifting away from a traditional emphasis on infectious disease, and toward a greater focus on NCDs and their risk factors.
Noting that other presenters at the conference had called for changing society’s behavior with regard to healthier eating, Dubé charged that efforts along these lines have so far fallen into two camps whose efforts clearly remain insufficient. One camp is that of the medical field’s emphasis on providing access to drugs and technology, which Dubé labeled a too-costly approach that fails to impact eating and prevent disease. The other camp consists of the public health field’s emphasis on promoting healthy eating and other healthier habits to the public, while ignoring the fact that most people need a great deal of support in changing habits. “Public health promotion can’t change human instinct,” said Dubé. “The modern environment has overshot critical limits of natural biology.” Government attempts to regulate food won’t succeed, either, added Dubé, noting that populations aren’t prepared to sacrifice their freedom of choice in food.
Dubé urged the world healthcare leaders at the Summit to embrace “convergent innovation,” an approach she has been pioneering for nearly a decade, and that has been receiving growing attention both inside and outside of McGill. Convergent innovation holds that innovative, effective solutions to complex problems can only come about when different potential contributors act collaboratively, and take into account the needs and ideas of other sectors when acting on their own. Dubé has been applying the approach directly to the problem of obesity and other NCD risk factors in her role as founder and scientific head of the McGill World Platform for Health and Economic Convergence (MWP). The MWP has been spearheading an international coalition of leaders from academia, government, business, and healthcare aiming to change enough aspects of the world around us to help individuals make healthier decisions about their behavior.
Dubé prescribed to the Summit attendees a three-pronged approach to improving efforts targeted at reducing NCD-promoting behavior:
* The private sector should be better integrated into the efforts. That means that policy and healthcare decision-makers need to work alongside companies to fashion solutions that work well for all parties. It also means that corporations need to pay more attention to health. “The private sector needs to get more serious in making human development and health a core driver of their innovation and investment,” said Dubé.
* Technological innovation should be applied to food and food consumption , especially at the community level, where people make decisions about which foods to buy and eat. Such innovation might be applied to consumer mobile-phone applications, for example, or to information-technology based distribution systems that better connect consumers with local produce.
* All interventions should be built around a deeper scientific understanding of human decision-making, down to the level of biology. “Everyday decisions and behavior are at the root of NCD-related problems and solutions, but remain largely ignored in intervention and public policy,” said Dubé.
Dubé noted that while obesity and other NCD risk factors have already become a major crisis in affluent Western nations, the developing world is catching up quickly. “It took the West 300 years of industrialization to get to this point,” she said, “but in low- and middle-income countries that process has been compacted to less than 30 years, even while many of these countries still fail to provide universal access to secure nutrition and healthcare.”
Dubé’s Summit comments appeared to be enthusiastically received, and after the Summit she said most leaders in the anti-obesity field seem to agree that the world must move toward more innovative, broadly integrated approaches. “But talking is one thing, and doing something about it is another,” she added. “This crisis is growing fast, and so far we still aren’t seeing enough convergent innovation.”
The MWP has been working to kickstart movement toward convergent innovation by building collaboration on a number of projects through a series of international workshops, most recently in New Delhi, India, with a follow-up workshop scheduled for Italy later this month. Some of these projects are already entering the implementation stage, including one that will facilitate the growing of nutrient-rich and non-obesity-promoting legumes by small farms in developing countries. Another project involves enlisting mobile phones and other high-tech tools to better monitor the health and nutrition of mothers and young children.
Both these projects, along with others, are backed by close collaborations of business, government, agriculture, healthcare and academia, as well as with the participation of the communities that stand to benefit from them. That community participation is one of the keys, Dubé added. “It’s not enough to have programs for the poor and vulnerable, the programs must also be with the poor and vulnerable.”
Dubé also criticized what she characterizes as a “doom and gloom” attitude that many experts have brought to the problem of obesity and NCDs. “Cassandra-style pronouncements have become too popular,” she said. “This problem can be solved, but we need to work together to change the way we’ve been approaching it.”