This course is multidisciplinary in nature, and aims to equip the global audience of interested lay people, people with chronic disease, public health researchers, health clinicians, students, administrators, and researchers to reflect on the overall impact of the burden of chronic disease . It shows how all chronic diseases (obesity, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and cancer) are related by a set of common causes, and that such diseases should be tackled, not individually, but as part of a complex system, with interrelated contributing factors. These factors are genetic, environmental, psychological, economic, social, developmental, and media related. The Charles Perkins Centre at the University of Sydney is a unique interdisciplinary education and research hub which seeks solutions to chronic disease through a complex systems approach. Academics in many disciplines (in Science and Medicine, but also in Architecture, Humanities, Law etc) work in a collaborative fashion to produce novel solutions to the problems of chronic disease. All contributors and participants in this course are members of the Charles Perkins Centre and will speak from the unique interdisciplinary perspective that this Centre affords. The course will describe a complex systems approach as the most productive way to ease the burden of chronic disease. It then describes these diseases in detail, their risk factors, and the environmental and biological factors that have led to the current epidemic of obesity, diabetes and cardiovascular disease. Finally, the solutions – and more importantly the process for finding solutions- is the subject of the last module. No one approach by itself can ever be the answer, and certainly not a simple diet and exercise approach. The entire course consists of 5 content modules, plus an extra module for completing assignments and discussions, and takes about 6 weeks to complete. Completion certificates are issued on the basis of participation in all 6 modules. What you'll learn: - How the Charles Perkins Centre recruits interdisciplinary teams to ease the burden of chronic disease - How a complex systems approach is necessary to provide solutions to a complex problem - The fundamentals of chronic disease research and where it is heading - The biggest risk factors for chronic disease and their global incidence - The biological, genetic, social, regulatory, and other influences that have inflated these risk factors - How to provide solutions globally for the reduction of chronic disease
A discussion: Solutions
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Easing the burden of obesity, diabetes and cardiovascular disease
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Module 5 - Solutions
In this module we will consider in detail the complex challenges of finding solutions to chronic diseases and how these could be brought together in developing a systems approach to address these major chronic diseases and the threat they pose to individual and population health.
与讲师见面
Stephen SimpsonAcademic Director and Professor, School of Life and Environmental Sciences
Charles Perkins Centre
So, Steve, this whole course is focused
on complex problems which obviously have complex solutions.
But they still have solutions.
And in many ways, that's what the Charles Perkins Centre was designed and
put together to do.
So I wonder if you could just recap.
On how the Charles Perkins Centre is approaching these serious problems.
>> Absolutely.
So these are very complicated problems and
admitting that is perhaps the very first step that we've had to take.
So it isn't obesity, metabolic disease, isn't just as simple as energy in,
energy out.
And that's traditionally been the way we've thought about it.
So no, it's a very complex interconnected set of factors that extend
from within the biology of individual humans like me and
you all the way through to populations and the way society and the world works.
And that's a really important admission.
But how do we go to the next step and tame that complexity and turn it into solutions
that are able to be sustained and implemented to good effect on health.
Well, what did we do?
The next thing we did was say what are the disciplines we need to bring
together to help come to that set of solutions?
And we found that there are many and various. We need clinicians and physicist and
people working in economics and engineers and agriculturists and so on and so forth.
So at the Charles Perkins Centre we've brought them all together in one place,
in one community of research.
And we've set them free to work on the things they're good at and
to provide local solutions that focus on the things that they're good at.
The next step however, is how do we put it all together?
So that it becomes more than the sum of the parts.
And I guess that's the challenge, isn't it?
>> Yeah, it is indeed.
And the nodes, I guess, that are being created by the Charles Perkins' setup,
are designed to take those components and then bring them all back together.
And it's, for me, it's been a great experience to be involved in
addressing these issues from the various aspects that we come from.
So for myself, I'm sort of focused more at the implementation end and
there are other people who are like yourself in a way.
And others who focus on the biology and other things.
And it's actually being quite a revelation to be able to work with
people from different aspects.
And often we get very into in what do and that consider the other aspects.
Now, I think it's really important for biologists and
scientists that, when they considering how they're addressing the problem of obesity,
to think of what their discoveries, how they can be translated
into solutions that finally will assist the person or the population.
>> No, that's absolutely right.
And we need our disciplines to also be credible and strong.
So a biologist or a clinician,
somebody working at the more translational end or
indeed a philosopher needs to be really good at what they're doing,
but in an environment where they can share their knowledge,
they can gain new knowledge by speaking to others in other disciplines.
And it's out of that set of new opportunities to collaborate and
communicate that we will and we are starting to see these emerging solutions,
which are more than the sum of the parts, which is ultimately where we need to go.
But then again, ultimately, we have to be able to take these
endlessly complex sets of collaborations and research projects, and
distill them down into things that people can actually do.
Either as individuals or as governments or
as people who are designing and formulating and producing our food.
And it's there that the real trick lies, isn't it?
How do we take all the new things we have learned and
how do we turn that into sustainable,
implementable solutions that are palatable to individuals but also to governments.
And I wonder have we any examples where that sort of approach might have worked?
>> Well, I think there are plenty of examples that have been used in terms of
approaches to other serious public health problems.
I think the obvious one is smoking >> Of course, yeah.
>> and tobacco control.
>> Yes. >> And I guess that has been the one that
we've been most successful with, unless you go back to cholera epidemics,
and things like that.
>> Yeah. >> But-
>> Yeah.
>> There's certainly different
infectious- >> Yeah.
>> Problems, so I guess a little
>> Potentially easier to address.
>> And actually that's
a really interesting point, because I think the infectious disease model,
where you have a complex outcome, a disease with lots of
different symptoms and consequences, has a single agent causing it.
An infectious disease agent and that allows you to devise a simple solution.
You can target that, either by protecting the host, by immunization, or
by a drug that kills the disease organism, and then you've solved the problem.
But that model doesn't work, does it?
For complex diseases like non-communicable chronic disease.
>> No, I think that, that's true.
And as we've discussed during this program that there are multiple risk factors,
and each of those risk factors do contribute to the overall problem.
And each of them have a slightly different way of being addressed.
But, just going back to smoking, we actually have seen some
of the strategies that have been used for
smoking are actually applicable to chronic diseases and obesity.
And although people try and distinguish smoking versus obesity
in terms of smoking being universally harmful which is not the case for food.
>> For food, of course.
Yes. Yes. >> Or physical activity etc, but
nevertheless there are some analogies which I think could
be successfully transferred and there are many other public health problems that
have been addressed where it's not quite so black and white.
I mean alcohol, for example.
>> Yes.
Alcohol in small quantities may actually be beneficial but
clearly in large quantities it's harmful. It's always harmful for children and
so we need to do things to protect children.
And similarly, you can actually give the same for some unhealthy foods
that are potentially harmful for children and so we should address this
in different ways with the different populations that we're trying to help.
>> So, if you take the smoking example as a combination of taxation,
regulation, public health messages.
And ultimately really, it came down to individual social networks and
peer groups deciding that something that used to
be considered cool was going to make you a social pariah if you
were smoking amongst a group of others who didn't.
And so that became a tipping point, didn't it?
In changing behavior across populations, but
it took how many decades to get to that point?
>> It took about 50 years or so in order for it to become socially unacceptable.
Interestingly, I've only been in Europe last week and
it was quite interesting because the locals were smoking in restaurants,
and it was interesting just to see the reaction of the foreigners in
that situation of not actually understanding how this could possibly be
allowed in a society like ours.
But we have just found it unacceptable.
>> Socially unacceptable and that's really significant shift that can drive
change not only at the individual level but right away through populations,
through communities and friendship groups and so forth.
So, are there any examples of the, well,
let's call it the tobacco effect when it comes to food and nutrition at the moment?
>> Well, obviously there are many countries that are introducing taxes or
levies on sugar sweetened beverages as a start.
The most recent experience has been in Mexico.
And the reports on the valuation have suggested this is actually proving
effective in terms of reducing consumption of sugar sweetened beverages and
increasing the consumption of water.
Other taxes have not been a success, well, I think we need to acknowledge that.
That the fat tax that was introduced in Denmark.
>> In Denmark, yes. Was probably not thought out, totally,
clearly- Well, before it was implemented.
And there were issues with cross border purchases, etc.
which were damaging to the local industry
and so it's understandable.
But that doesn't mean to say that some form of regulation and
taxation isn't necessary.
>> isn't part of the armory, but it also raises, I think,
two really important points.
One is that we need to have evidence as to whether something works.
In that case of sugar tax and its implementation in Mexico.
Because that evidence is critical to shaping future actions,
when it comes to solutions.
And I think the other thing that the Danish example shows,
which is an inevitable part of any complex system, and
that is you can get unintended consequences.
And we need to be all the time aware of that and
ready to measure things that you mightn't expect to have to measure.
So, in the case of taxing fat in that case, all you did was encourage
overseas tourism in Denmark which was unintended.
But it was an interesting outcome nonetheless
and it helped shape what you do next and
it also shows that within a given set of circumstances within a given country,
the same intervention may not actually be
as effective there as it is somewhere else.
Nor for that matter amongst different groups of individuals within the society.
And I am sure there are examples of that.
>> And I guess that's how we operate in science, it's often two steps forward and
one step back if you're lucky and sometimes one step forward and
two steps back till you get the solution.
>> [LAUGH] Exactly.
>> So I think we do need to be prepared to make our suggestions, try them,
evaluate them and if they clearly are not working then reconsider.
And I think that applies across the board.
And clearly education is also an issue and
bringing along civil society in terms of anything that we need to do.
Because ultimately this sorts of legislative or
regulation and that's not solution but there is a lot of policy decisions
that can be made by government- >> Absolutely, yeah.
>> And I have quite considerable ramifications in terms of
the potential unwanted consequences.
>> I think we under value the power of the individual in these things.
And we may educate and education is critical to people being able to
make their own judgements about what they should do and what they should ignore
when it comes to the clamor of advice that's coming to them.
But once you've actually explained to somebody and
they've made that decision in their head as a result of their own
thinking about it and their peer groups and their social networks,
then that ultimately has power to change things through the power of purchase.
People ultimately spend money.
And if they don't buy certain things, then that will directly impact the companies
that make them and drive change and through the power of votes.
If you're going to vote for
a government that is supporting your health then governments listen.
Without the power of economics and
political authority not much happens in societies.
So really the individual is critical.
>> Yeah, we often talk about individuals and populations but
populations are just a bunch of individuals.
And I think it's important for everyone to appreciate that if they feel strongly
enough about this as an individual- >> Right.
they can make the difference, not only to themselves and their own individual and
their family health- >> That's right.
>> they can make a difference in influencing government and policy.
>> And that relationship between individuals and populations
is a nonlinear one as well, like any complex system.
So the behavior of a crowd
is far more than the sum of the individual behaviors of the components.
And so you can get a social movement emerging out
of simple behavioral changes that are made by individuals.
And because of the way they're transmitted through the family groups,
their communities, their social networks,
you can have huge power and influence in a way that is just
not easily seen if you were to think, 'Well, all I am is one person amongst millions.'
So that transformative influence of your
small tiny behavior changes at your level, not any can change your own health,
it can impact the rest of the world quiet literally.
>> And I think we've seen much more attention paid to these social networks.
I mean, not only in terms of the benefits but also the negatives as well.
[CROSSTALK] Very much associated with obesity as well.
And they I think occur in a passive sort of way.
And I think making people aware that this is actually influencing them,
I think, is a step towards a solution.
>> And of course, the power of advertising is exerted through social networks too.
So it cuts both ways and
we need to be able to play the game, if you like, in public health
that is played by people making and selling things to us.
And we need to be as sophisticated in our use of and
expenditure of that understanding through these networks.
>> Do you think we're making any progress in terms of raising awareness about
the critical life stages that influence what becomes of us later on,
especially around early childhood in those first a thousand days?
>> The case is becoming stronger and stronger isn't it?
That if you effect a change, an improvement in lifestyle let's say or
an improvement health very, very early in life you will
gain the benefits throughout the whole of the life course.
And that benefit will get bigger and bigger and
bigger as you go through your life.
So a little tiny adjustment early in life
can set you on a trajectory to better health as distinct from
a life where you're really suffering poor health outcomes,
not only a great cost to you but also societal cost as well.
But, I think, even more exciting Is that we are now understanding that
the decisions that are taken before you are even born,
you're born with a compliment of genes but it's how those genes are switched on
which will set you on a trajectory just at birth.
That's set by the behavior by your parents and even your grandparents so
we have tremendous power to change even the next generation before they're born,
and you get that accumulating benefit across generations.
And after all, that's how human civilizations and culture have emerged,
by transmission of new knowledge from one generation to the next and
you can then stand on the shoulders of giants.
Whereas if we break that link and something as simple as
the loss of an understanding of how to cook, can be the breaking of such a link,
you're essentially condemning generations to follow to worse health
than would otherwise be the case.
So it's like losing a language.
>> So to me it's, I think we have as you said a fair amount of evidence
to support the importance of that view, and I guess it's somewhat frustrating that
policymakers and governments haven't embraced that a little bit more.
Because it seems such an obvious thing to do,
that I don't think there would be anybody in civil society who would rise up
against governments that took some action to improve the health of our children.
>> Well, and that's why for example our economists here at
the Charles Perkins Centre are doing such an important job
in providing the economic evidence that, if you make a change early in life
which could be relatively inexpensive change, you will reap the benefits
in a ratio which far exceeds the initial investment in making that change.
And those economic arguments carry great weight
in a society which we've built based around the power of money and
its ultimate influence over politics in our lifestyle.
So, that's why we do have our economists working here, it's exactly why.
>> Yeah, I guess it's just another illustration of how all these groups
working together can make a difference.
>> Right, right.
>> And I think the other area in which this is particularly
important is indigenous populations, and
I think also the Charles Perkins Centre has embraced indigenous health and
the special place that it has in our society and the fact that it does need
in some ways more urgent attention than >> Absolutely.
>> The general population >> And
it's why of course that our namesake is Charles Perkins.
Himself a famous Australian indigenous man,
an aboriginal man, who suffered ultimately poor health,
but made great changes to the way society thinks of the complex
issue of aboriginal social affairs in this country.
Yes, that's a critical part of what we're doing.
>> So ultimately, how long do we have to wait
do you think before the solutions are put in place?
>> I must say, if you look at what we've managed to achieve in only four years.
So, the Charles Perkins Centre as a building has been now opened for
only two and a half years or just under.
The project is only four years old since we implemented the strategy.
To have achieved what we've achieved in that short period of time,
to bring more than a thousand people together across
all of these different disciplines, now discovering new and exciting things.
That gives me great hope that the next stage, which is the hard bit,
will emerge over the coming decade in a way that we can't even imagine,
but I think will inevitably happen by way, we built this in the first place and
just as chronic disease is a set of complex problems, it's a complex system,
so, too, is the way we're addressing it based around those same principles.
And if you get them right, you get impact and
outcomes for free that you couldn't even imagine.
>> I do share your optimism,
not only in the contribution that the Charles Perkins Centre is making,
but having been around awhile, I see how things evolve.
And I think in the last few years, people are now starting to take
the chronic diseases and obesity much more seriously than they have and
>> Right.
>> we've only had in the last couple of weeks a
politician from a side of politics that we wouldn't think we'd hear this view
from, suggesting that maybe it is time for us to consider a sugar sweetened beverage tax
>> Right. >> in Australia and
I think that the discourse and
the conversation- >> Yes.
>> Is changing.
>> It's shifting, isn't it?
Yeah.
>> And, obviously, it's going to take a little bit longer,
because there's still a lot of people to influence, and minds and hearts to change.
>> Yes. >> But I think slowly we're getting there.
>> And we're getting, we're hearing in the mouths of politicians and
particularly people who you would expect to have the view that
we should eat less and move more, it's somehow ultimately our own responsibility.
Now an acceptance that that really isn't a suitable answer.
That's by no means a solution and it really isn't an ethical answer either.
And just that shift in mindset amongst the least likely
to make that shift is, I agree, absolutely encouraging.
>> And the shift in the mindset is really part of the solution.
>> That's it, that's the flick that then
pervades an entire system exponentially, quickly.
So becomes more than the sum of the parts, yeah, I agree.
>> And so that switch in attitude is, in itself an essential part of the solution.
>> That's exactly right.
So that flip in mindset will become the spark that
will be transmitted throughout the social networks and ultimately change the way
society thinks about these problems and that is exactly what we're talking about.
That's a complex system having shifted phase and
it's making that phase shift that will mean that we've ultimately succeeded.
So I dunno about you.
I think we're now sitting ready for that to happen and I really can't wait for
the next decade because there's going to be amazing things happening.
>> I agree, I agree.
I think that this is time for incredible optimism and
I think we will see some action In the very short future.
>> Excellent.
>> [INAUDIBLE] some sample.
>> So he's just getting the background set.
Okay?
