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A discussion: Solutions

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Easing the burden of obesity, diabetes and cardiovascular disease

4.5（36 个评分） | 3.4K 名学生已注册

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

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4.5（36 个评分）

5 stars
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RM

Aug 22, 2018

This helped me to understand the nature of NCDs, as well as the things we can do to prevent ourselves from being prey to these

WF

Jan 28, 2018

Excellent course. Not too long, not too short. Useful for those with a scientific and non-scientific background.

从本节课中

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.

Module 5 Introduction5:44

A discussion: Solutions23:17

What is one solution?4:59

教学方

Stephen Simpson
Academic Director and Professor, School of Life and Environmental Sciences

脚本

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?

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