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Bodies and buildings 2 nyu itp 9 15 2014

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Bodies and the global obesity epidemic. Why were we so surprised? Systems Thinking - Single and Double Loop learning.

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Bodies and buildings 2 nyu itp 9 15 2014

  1. 1. BODIES & BUILDINGS NYU ITP LECTURE COURSE FALL 2014 CLASS 2: SEPTEMBER 15, 2014 JEN VAN DER MEER @JENVANDERMEER WWW.JENVANDERMEER.COM
  2. 2. LEVERAGE POINTS Class assignment for 9/15/2015 Mandatory! Read ALL OF Donella Meadows: Leverage Points: Places to Intervene in a System Take leverage points 9, 8, 7. Write a 1 page or 500-6000 word essay on the following topic: How do mobile apps try to affect leverage points 9, 8, and 7. 9) The length of delays, relative to the rate of system change 8) The strength of negative feedback loops, relative to impacts they are trying to correct against 7) The gain around driving positive feedback loops Give one example and explain how the app is or is not designed to affect each of these leverage points. How effective do you think this app will be at changing behavior? You will be asked to present your work, so practice rehearsing your in class presentation at least two times. 2
  3. 3. THIS WEEK Leverage Points: Places to Intervene in a System Take leverage points 9, 8, 7. Write a 1 page or 500-600 word essay on the following topic: How do mobile apps try to affect leverage points 9, 8, and 7. 9) The length of delays, relative to the rate of system change 8) The strength of negative feedback loops, relative to impacts they are trying to correct against 7) The gain around driving positive feedback loops Give one example and explain how the app is or is not designed to affect each of these leverage points. How effective do you think this app will be at changing behavior? You will be asked to present your work, so practice rehearsing your in class presentation at least two times. 3
  4. 4. PLACES TO INTERVENE IN A SYSTEM: 12. Constants, parameters, numbers (subsidies, taxes, standards) 11. The sizes of buffers and other stabilizing stocks, relative to their flows 10. The structure of material stocks and flows (transport networks, population age structures) 9. Length of delays, relative to the rate of system change 8. The strength of negative feedback loops, relative to the impacts they are trying to correct against 7. The gain around driving positive feedback loops 6. The structure of information flows (who does and does not have access to what kinds of information) 5. The rules of the system (such as incentives, punishments, constraints) 4. The power to add, change, evolve, or self-organize system structure 3. The goals of the system 2. The mindset or paradigm out of which the system – its goals, power structure, rules, its culture-arises 1. The power to transcend paradigms 4
  5. 5. BODIES IN THE NEWS Apple Watch and Healthkit launch – a Major Platform for Innovation Ebola Virus – no mHealth efficacy. Mobile Health Apps Have Role In Ebola Crisis 5
  6. 6. FIRST: HISTORY OF SYSTEMS THINKING BODIES & BUILDINGS 6
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  9. 9. 9 SYSTEMS THINKING QUESTION WHY DO WE COLLECTIVELY CREATE RESULTS THAT NOBODY WANTS
  10. 10. 10 SYSTEMS THINKING IDEAS Mental model: an explanation of someone's thought process about how something works in the real world. “We cannot solve problems with the same kind of thinking that created them.” Albert Einstein Modeling systems: we are limited in our capacity to form and reform mental models. Systems modeling allows us to move from “what” to “what if” - to see our thinking.
  11. 11. 11 STOCKS, FLOWS, LOOPS Stocks: foundation of a system. You can see, feel, count, and measure. Flows: Stocks change over time through the actions of a flow. Loops: A feedback loop is formed when changes in stock affect the flows. • Balancing: feedback loops are stability seeking and try to keep a stock at a certain level. Balancing process intends to reduce a gap between a current state and a desired state. The balancing (negative) feedback adjusts a present state to a desirable target regardless whether the trend is descending or ascending. • Reinforcing: feedback loops occur when a system element has the ability to reproduce itself. If the trend is ascending, the reinforcing (positive) feedback will accelerate the growth. If the trend is descending, it will accelerate the decline.
  12. 12. 12 A TEST http://youtu.be/1D07neiB7HI https://www.youtube.com/watch?v=KmkVWuP_sO0
  13. 13. POPULATION GROWTH 13
  14. 14. MORALE 14
  15. 15. 15 SYSTEMS ARCHETYPE, DELAYS Systems archetype: patterns of behavior in a systems expressed by circles of causality. Delays: time between when an action is taking and the current state changes. http://www.systems-thinking.org/theWay/sbd/bd.htm
  16. 16. 16 FEEDBACK LOOPS “In our current complex global systems, decision-makers often affect large groups of people with their actions but never see, feel, or become aware of their actions’ consquences. Without feedback, or with delayed feedback, there is no learning.” _Otto Scharmer, Leading from the Emerging Future
  17. 17. BODIES: THE OBESETY EPIDEMIC BODIES & BUILDINGS 17
  18. 18. BODIES + We have made huge strides in life expectancy, but we have reached limits of growth. 18
  19. 19. NATIONAL OBESITY CRISIS 19
  20. 20. US OBESITY GROWTH RATE 20
  21. 21. Today’s children may well be the first generation of Americans whose life expectancy will be shorter than that of their parents. 21 OBESITY TRENDS
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  25. 25. Data from 3,139 counties in the U.S. Quintiles are cohorts of counties ranked by the percentage of people living with poverty. Levine J A Diabetes 2011;60:2667-2668 Copyright © 2011 American Diabetes Association, Inc.
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  27. 27. DIGITAL DIVIDE + DIABETES Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access. Urmimala Sarkar, Andrew J Karter, Jennifer Y Liu, et al. J Am Med Inform Assoc 2011 18: 318-321 originally published online January 24, 2011. 27
  28. 28. GLOBAL OBESITY PANDEMIC “GLOBESITY” 28 GLOBAL OBESITY: TRENDS, RISK FACTORS AND POLICY IMPLICATIONS. VASANTI S. MALIK, WALTER C. WILLETT & FRANK B. HU. NATURE REVIEWS ENDOCRINOLOGY 9, 13-27 (JANUARY 2013)
  29. 29. Figure 1 Global trends in the prevalence of obesity among women and men in 1980 and 2008 from select regions of the world Malik, V. S. et al. (2012) Global obesity: trends, risk factors and policy implications Nat. Rev. Endocrinol. doi:10.1038/nrendo.2012.199
  30. 30. 30 Women
  31. 31. September 16, 2014 31 Men
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  35. 35. OBESITY + GLOBALIZATION 35
  36. 36. THINKING IN CIRCLES ABOUT OBESITY APPLYING SYSTEMS THINKING TO WEIGHT MANAGEMENT. TAREK K. A. HABI 36
  37. 37. HOW THE PROBLEM SNEAKED UP ON US As the upward and outward trend in the population’s weight and waistline accelerated in the late 1980s and 1990s, most public health experts failed to perceive the escalating threat. • Unlike communicable diseases, no immediate symptoms. • Initially only affected a few people. • The science establishing links between diet, weight and health were just beginning. 37
  38. 38. HOW MANY CAUSES CAN WE COUNT? 38
  39. 39. BUCKET THEORY OF MIND • Minds seen as containers – Karl Popper. • Public understanding is viewed as a function of how much scientific facts are known. • How many scientific facts public minds contain. • Irony: Americans know more about food and nutrition than in any time in their history, but they are gaining more weight. • “Knowledge (in the bucket) without the requisite decision-making skills will produce little change. 39
  40. 40. THE LEVERAGE (OR THE IMPEDIMENT) IS WITH THE PEOPLE • In the US, most obese individuals attempting to lose weight do so themselves, without seeking professional help. • Weight has been seen as an individual, personal problem. • The wellness movement is rooted in the concept of personal control. 40
  41. 41. WE ASSUME MORE CONTROL THAN ACTUALLY EXISTS • Obesity is a complex multi-factorial disease involving genetics, physiology, and biochemistry, as well as environmental, psychosocial, and cultural factors. • In managing our health – and our bodies – we are decision makers who are managing a truly complex and dynamic system: the human body. • Living systems do not come with an operator’s manual. It requires skills to see through complexity to the underlying structures generating a complex situation or problematic behavior. 41
  42. 42. IT’S SO EASY CALORIES IN. CALORIES OUT. 42
  43. 43. MORE COMPLEX THAN THAT • Body’s homeostatic process- adaptive (and defensive) mechanisms that continuously aim to maintain the body’s internal stability. • Weightloss is not linear, but curvilinear. • Unrealistic optimism causes us to ignore legitimate risks. • Failure to learn from failure. Learning has not occurred. 43
  44. 44. PHYSIOLOGICAL ASYMMETRY • Humans are wired to compensate for caloric dilution but not the reverse. • Asymmetry in energy expenditure- basal metabolism. • Asymmetry in energy storage- when body fat is shed during weight loss, the size, but not the number, of fat cells dwindles. 44
  45. 45. SINGLE LOOP LEARNING 45 Consequences Decisions, Feedback Actions Single loop
  46. 46. SINGLE LOOP DIETING 46
  47. 47. SINGLE LOOP LEARNING • Often we find ways to move closer to our desired state without changing our mental model. • Learning to use life’s raw experiences to adjust our entrenched worldviews is hard and, therefore, uncommon. • Experience, after all, provides only data, the raw ingredients for learning, not knowledge. • Single loop: we learn to tweak our decisions without altering our mental models or their associated decision rules. • (A thermostat that senses when it is too hot or cold). 47
  48. 48. SINGLE LOOP DIETING 48
  49. 49. WHAT IS TO BE DONE CHALLENGE INGRAINED ASSUMPTIONS 49
  50. 50. DOUBLE LOOP LEARNING 50 Consequences Feedback Mental Models Of Real World Decisions, Actions Decision Rules, Strategies Single loop
  51. 51. DOUBLE LOOP LEARNING • Learning that occurs when we use the feedback information to enhance our fundamental understanding of the decision task. • Learning is discovery of mental maps and decision rules that are better aligned with the decision task at hand. 51
  52. 52. SHIFT IN PUBLIC POLICY • From: stuff buckets with nutritional guidelines/scare into good health • To: challenge people’s deeply ingrained assumptions. Provide them with the conceptual skills to JUMP. • From: attention on the separate mechanisms of human weight and energy regulation. • To: the hole bioenergetics systems as an integrated operating system. 52
  53. 53. FRAGMENTIC ANALYSIS LENS • Nutrition out of the context of lifestyle • Biology out of the context of behavior • Behavior out of the context of environment “The performance of any system (whether it is an oil refinery, an economy, or the human body) obviously depends on the performance of its parts, but a system’s performance is never equal to the sum of the actions of its parts taken separately. Rather it is a function of their interactions.” 53
  54. 54. SHIFT IN CULTURAL UNDESTANDING • From: solely individual interventions. A sole focus on the obese person and how to help them gain control. • To: Why is society obese. How can we help society. 54
  55. 55. SHIFT HEALTHCARE PRACTICE 55
  56. 56. NETWORKED MEDICINE 56
  57. 57. ASSIGNMENT: SEPTEMBER 22 57 September 16, 2014
  58. 58. DEFINITELY READ/WATCH Required Reading: Video: Global Obesity at an All Time High With Billions Overweight Newsy Network Medicine — From Obesity to the “Diseasome” NEJM. By Albert-László Barabási, Ph.D. The epidemic of pre-diabetes: the medicine and the politics The BMJ by John S Yudkin, Emeritus Professor of Medicine, University College London, UK and Victor M Montori, Mayo Clinic, USA September 16, 2014 58
  59. 59. EXTRA Video: Technology, Diet and Obesity Related Disease: From Children to Adults Endocrine Society, David S Ludwig, MD,PHD Boston Children's Hospital, Boston, MA The Spread of Obesity in a Large Social Network over 32 Years NEJM, by Nicholas A. Christakis, M.D., Ph.D., M.P.H., and James H. Fowler, Ph.D. Catching Obesity From Friends May Not Be So Easy, NY Times, by Gina Kolata, August 8, 2011. We Are Our Bacteria NYTimes, by Jane Brody July 14, 2014 The Weight of the Nation: Part 1 - Consequences (HBO Docs) 2012 (and keep going – HBO has the entire series on YouTube). Catherine Kerr on Cortical Measures in Mindfulness Meditation at Quantified Self. September 16, 2014 59
  60. 60. ASSIGMENT When developing ideas and concepts for our student projects, and future projects, business ideas, and save-the-world ideas, we often start by designing for ourselves. For this assignment, research a part of the world at a local level (city, state, province, county) that has a problem with obesity. In a one page essay, describe the social, cultural, technological, economic, and other conditions of this region that may be contributing to a growth in the prevalence of obesity. Map the system of obesity in this country. What is the one recommendation you would make to government, business, or the citizens of this country to slow the growth of obesity? 60
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