I bumped into Hugh Fearnley-Whittingstall a couple of days ago and filmed a little sequence with the Newcastle Can production crew.
It's an ambitious project. I've signed up for all Hugh's campaigns. I am now a model recycler, and I've managed to reduce my personal consumption of fresh ivory by 20% in the last 6 months alone.
This is an interesting project because it's a population change.
Even public health departments are spectularly ineffective at that.
Setting it as a Challenge is a good way to go because success is not guaranteed.
Of course, ownership must be given to the people.
And the hope is they will take it up!
But look at the comments on this website for Hugh's recent visit:
The comment-maker rightly points out the Newcastle already has quite a lot going on for the already motivated. The question being how to reach the unmotivated.
But this is the telling line in his comment "They'll need to move quickly though to make some changes within a year".
Notice the way he says THEY and not WE.
That is people sitting back waiting for a magic wand to be waved.
Doctors have failed at this over and over again.
Doctors TELL people to lose weight, but it's the creeping threat of death sidling and sliding into view in the wing mirror that makes change stick. When it's a little late.
The dietician hands out dodgy government advice, changing that advice with the wind. Still believing that leaflets change people.
A strange rival creature called the "nutritionist" busily promotes all sorts of bogus nonsense that gets flogged in Holland & Barrett.
Between us, we've all confused the nation.
Low-fat diets? It defies all logic that anybody would think eating fat would be a bad idea for homo sapiens.
Low-cholesterol foods? We make cholesterol. We don't buy it in.
Gastric bypass surgery? Ask any gut surgeon and he will tell you it's the best thing since sliced bread and refer you to his private clinic. He will surgically butcher your intestines and yes, you will lose weight.
And yet it is possible to reverse type II diabetes in 2 weeks without surgery. That research came from Newcastle.
It is possible to get people up and get people going.
But not by telling them.
It might be a little bit of push, but it's also a little bit of pull. Pulling people along, and people pulling together. Giving them a reason to bother.
Change is a vector.
Targets are good but momentum is better.
Life-shortening habits decay more and more when people are just busy surviving.
Tricks and hacks are really what people need. It needs to be fun - with a little game theory thrown in for good measure.
And the irony with a population approach, is that you need to find the trigger for the individual. That's tough.
So you need people to help find each other's trigger. Push each others buttons.
Can an individual lose weight? Of course.
The one thing we've learned from TV diets is that any single diet at all works perfectly well. It is being followed by a camera crew that makes it successful. Another paradox. The day they disappear, of course, they are back to square one.
Last night there was a BBC programme following Frank Gardner - the disabled BBC journalist. He was birdwatching in Papua New Guinea. Sadly, the tribe they met had been visited in the past by American missionaries who brought them down from the hillsides to convert them to Christianity. By the time that the missionaries left, the tribe had culturally lost the skills to survive on the hillside, and now the children were suffering from malnutrition. The reason for Star Trek's Prime Directive, I suppose.
It is oddly easy to cherry pick the most motivated without having any impact on a population.
Populations are not individuals. It's a counterintuitive thing.
There's a lot of counterintuition in healthcare. Tell somebody to stop smoking for example and most people get so anxious that they have to run off to their favourite purveyor of fine tobaccos and buy a pack of fags.
Can a community do it?
What do we even think community IS at the moment?
A community has to be built or rebuilt before it can be charged with a task.
But we have a growth of anxiety, shyness, depression, and people who can't function unless they are staring at a portable telephone.
How do we bring sustainable long-lasting change to a population?
Well, you can't follow everybody with a TV camera.
The project is to make a City healthier. Not an individual.
Of course, the great thing is that the end result - a TV programme - is exactly the sort of thing can reach into all those houses. The only problem then is that the audience we really need to get on board is actually watching ITV2.
The one thing we know for a racing certainty is the problem is getting worse, despite all the public health measures that have been thrown at it.
The one thing we know for sure, is that everything we have been doing so far is, at a population level, failing.
It's a question of strategy.
Take the glut of psychologists we are currently churning out...America did this in the 80s when everybody had a counsellor and a free course of Prozac.
Now we too have never had more psychologists...and, guess what, we have never had more mental health problems.
It is an absence of strategy.
The psychologists cherry-pick easy cases.
I can tell you what happens to the people who really, really need help.......
They get discharged from the caseload. They become invisible.
They don't darken the day of the cognitive behavioural therapist, because they prefer somebody a little bit more fragrant. A little bit more attractive. A bit easier.
The angry man who is too angry for anger therapy? Case discharged.
The shy man who is too shy to turn up for his session? Case dismissed.
The depressed patient who is not getting better? Discharged from CBT services.
The man who is crying for help so loudly in A&E, that the staff nurse calls the police? Case removed.
But these people don't go nowhere.
Medicine is the art of communication; doctors its supposed experts. That means expert with everybody. No cherry-picking.
If you're a psychologist or a dietician and your pony can only do one trick, you have a problem.
So they dismiss those people from their caseload and that problem appears to disappear. Ta-daaa!
These populations are full of people who think everybody's forgotten about them.
You don't change populations without at least trying to change the tough cases. Because that is when you must the right question.
And the right question is... "How can I help?"
You might start with "Why is what I'm doing not working?" But that is ego.
The question really is... "How. Will. I. Help?"
A good strategist has multiple options in play.
Different strokes for different folks.
I'm an optimist. I know this is all possible. I spend most of my life disagreeing with doctors who suggest it's all a waste of time, who won't use their time to work out strategies with their patients, who prescribe drugs over personal change.
I look forward to watching the show on TV and punching the air at the zenith
Unless I can find a fish to have a #fishfight with.
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