There are four available responses to the healthcare crisis arising from increasing rates of obesity, diabetes and lifestyle related disease.
More efficient hospitals or primary healthcare facilities. This would mean patients would come in and out of the healthcare system faster, return less often.
New drugs. For example, to increase metabolism or reduce desire (for food or cigarettes).
More readily available surgeries. It’s possible that something like lap-band surgery will become routine, like an appendectomy or colonoscopy.
Individuals change their behaviour. Primarily, this would involve eating less and more nutritious food and increasing the amount of physical activity they do.
If we are to divert from our current trajectory (of most of us getting fat and dying from lifestyle related disease) then a mixture of all four will likely occur.
On improving the healthcare system, there will no doubt be improvement in the long-term. Short-term however, it’s not likely there will be a systemic improvement to greatly improve things. Given the majority of a person’s healthcare costs come in the final years of their lives and the baby-boomer generation is about to enter that phase, we can expect the system to become less and not more efficient in the next few decades.
On drugs and surgeries, there’s no doubt these will proliferate – humans will always take the path of least resistance when it comes to change, and the ‘insta’ nature of such options makes them attractive. But such options aren’t yet widely or readily available.
Which leaves us with individual behaviour change. It’s free, immediately accessible and there’s sufficient available resources to solve the problem.
Yet, while it’s the most accessible option, it also requires a tidal shift. Normal people don’t want to eat less pizza, don’t want to say no to a glass of wine, and don’t love waking up an hour earlier to walk or run or ride before their day begins.
But I’m most excited by the fourth option.
Lifestyle change is a tide that rises all boats. Whatever you are – boss, father, sister, employee, lover, partner, friend, artist, thinker or process worker – lifestyle change (eating less, sleeping more and being more active) will make you a better version of it.
I can’t stop listening to Keith Jarrett’s Koln Concert.
My Dad listened to it in the 70s. My brother got obsessed with it in high-school and I finally fell into it last year.
The record has an amazing story. I’d assumed it was just an obscure thing that I’d lucked into. Turns out, it’s the best-selling solo album in jazz history and the best selling piano album of all time.
It was recorded at a concert organised by a 17-year-old German concert promoter.
The piano it was recorded on was “in poor condition“, “tinny and thin in the upper registers and weak in the bass register, and the pedals did not work properly” forcing Jarrett to focus on playing in the middle of the keyboard.
The show almost didn’t happen due to a number of mishaps and started unusually late at 11.30pm.
Within all these constraints, Jarrett created a lasting, timeless, transcendent piece of music.
It still sells well today. And still makes sense to my ears, with no context, no press, no promo or momentum.
I have been thinking about timelessness a lot lately.
I’m reading Paul Kelly’s memoir ‘How To Make Gravy‘. Few artists make me feel the way Kelly’s music does. I can’t listen to the song ‘How To Make Gravy’ without welling up.
In ‘How To Make Gravy’ (the book), Kelly talks about The Triffids’ ‘Born Sandy Devotional’ as a “cathedral” of a record.
I bought it to find that ‘cathedral’ but it doesn’t make sense to me. I can’t hear whatever Kelly’s hearing. And yet, I’ve been listening a lot lately to the Paul Kelly record ‘Comedy‘ which came out a few years after ‘Born Sandy Devotional’ and it sounds incredible.
I was moved by the recent Pearl Jam ‘Twenty’ documentary. My musical ears awakened around the same time ‘Ten’ was released (incidentally, the same year ‘Comedy’ was released).
‘Ten’ has now sold almost 10 million copies. Most of its songs were written as demos by the band in order to try and find a singer. When Vedder was given the demos by the drummer from the Red Hot Chilli Peppers, he wrote lyrics to them.
Those lyrics and demos became ‘Alive’, ‘Once’ and ‘Black’. From there, the rest of the album took less than a month to complete.
Pearl Jam followed ‘Ten’ with ‘Vs’ and ‘Vitalogy’. In the last 20 years, I’m convinced this is the best debut, sophomore and third album stretch from any band.
But Pearl Jam’s best work, both culturally and commercially, came in those first few weeks. A band whose legacy stretches 20 years, created its best work as strangers, in its infancy. And now, looking back, the band cringes at the way the record was mixed.
Like Jarrett, Pearl Jam looks at its most successful work with a tinge of dismay. And yet, you could argue that a best-of record from ‘No Code’, ‘Yield’, ‘Binaural’, ‘Riot Act’, ‘Pearl Jam’ and ‘Backspacer’ wouldn’t come close to touching the greatness of ‘Ten’.
I saw ‘Midnight in Paris’, Woody Allen’s latest film, and got to thinking – which writers, artists and musicians will we still be talking about and discovering in 20 and 30 years?
You think of Hemingway, Fitzgerald, Man Ray, Picasso, T.S. Elliot, Degas, Rembrandt, Dali and Tolouse Le Trec from the era depicted in ‘Midnight In Paris’ – who are their modern day equivalents?
So much of what we consume now is timely, and not timeless.
You think of Drake or The Weeknd or Two Door Cinema Club. Much as I like each of them, you can’t imagine that they’ll stand the test of time. No-one’s going to be listening to ‘Underground Kings’ 20 years from now.
My favourite release of 2011, was definitely Bon Iver’s self-titled album and ‘Beth/Rest’ was my favourite song of the year.
“I … feel really good about the “Beth/Rest” lyrics, because they come from this 14-year-old, innocent place where I’m not trying to say something super complicated. I allow myself to say certain things that mean a lot to me …
I love that song. I cried while working on that song. I know what that means, where that comes from, and why you cry for music. It isn’t for ironic reasons. It’s for either sad or joyful reasons. And that song is joyous to me. I don’t think it’s going to end up being the biggest statement of my career because I have so much more to learn and grow. But I love it as the last song on this record. It feels so good.”
As a representation of everything sport can be, American football is as good as it gets.
Every NFL teams is, in fact, 3 teams. Offense. Defense. Special Teams. Each of these has its own strategies. It’s like playing chess on three boards with three sets of different pieces. But unlike chess, where you react after a move has been made, each NFL team is balancing a proactive strategy (like, sack the quarterback) with a reactive one (like, shut down the wide receiver) in real-time. You react as, and not after, things happen.
Balanced against planned strategy, is what happens amidst the chaos. With so many moving pieces, mistakes are made, people slip, balls are fumbled – in which case, the strategy is replaced by instinct. This means that every play has value. There are no lost downs.
Strategically, it’s a little like spin bowling in cricket. You build pressure and tempo through successive overs and successive spin types which often leads to a wicket. But sometimes you also get an unplanned ball landing on the edge of a crack or a taking a top edge for 4. And you have to be equally prepared for both.
What makes a series of downs more interesting than an over of cricket though, is that you know that everything is building to a third down. Much like a full count in baseball, the 3rd down is unmissable, because that’s where games swing.
Which makes for another great thing. The NFL has a predictable rhythm, but highly unpredictable outcomes.
This is enhanced by the tension between the proximity and difficulty of making scoring plays. Much like in soccer, where a team can be cruising and dominant at 2-0 and then a momentary lapse can bring the score back to a tension filled 2-1, NFL games are filled with that same tension.
It’s incredibly difficult to score a touchdown, but one lapse by the defence and a seam can open up for the opposition to score. 7 points. And they’re back in the game.
Each down provides an opportunity for opposing players to do battle. So while the teams are executing an overall strategy, on most plays, two individuals will be competing at maximum capacity and this makes for compelling viewing.
Many sports offer the thrill of one-on-one competition, but generally the intensity of that competition peaks near the ball. The NFL’s one-on-one competitions have a standard intensity across the field, regardless of where the ball lies.
You want to know if Darrelle Revis is going to shut down his opponent. You have to know who’s going to stop Clay Matthews.
In an athletic sense, the NFL allows for incredible diversity – the 325 pound tackle and the 160 pound running back, going head to head. QB’s aside, so long as you have speed, there’s a place for you in an NFL team.
The fact that NFL players wear equipment adds a super human element to the battle, allowing players to test the limits of human physicality with car-like collisions. I don’t know why, but the anticipation of a collision is one of the NFL’s most compelling features.
AND
Within the intricacy of the broader strategy lies intense personal battles. These are made all the more interesting by character players – TO, Ray Lewis and Ochocinco for example.
Outside of the player to play battles, the city to city battles add a further layer of intrigue. You have to watch the Eagles play the Giants this season because of their epic battle last season. You have to watch the Jets play the Pats. You have to watch the Ravens play the Steelers.
And then finally, amidst this context and complexity and competition and collision, you have the quarterback, the game in his hands for just a few seconds, compressing extraordinary sensory complexity into a single tunnel of vision.
Imagine a free kick in soccer. Now imagine the kicker. That’s the quarterback. His team’s role is to protect him while he kicks. The opposing team’s role is to do whatever they can to physically attack him as he’s attempting to kick. And rather than kicking to a goal, he’s kicking into a series of moving windows that contract and expand to one square meter in surface area roughly every half second. Now imagine the kicker has, on average, 3 seconds to decide which window to kick into. That’s the NFL. Every play.
It makes for unmissable viewing, compelling sporting narratives, incredible competition and athletic excellence, intelligence, strategy, planning and instinctive reaction.
It’s not my favourite sport. But as a sports-fan, I can appreciate that it’s the best.
I finished this book last night. It’s good. You should read it. So much has already been written about the book, but there is some stuff in it that just amazed me.
Jobs spent years eating at a restaurant his biological father ran. He didn’t know that the man whose restaurant he was eating in was his father and his father didn’t know the Jobs was his son. They even shook hands at one point.
Right up to taking Apple back over, Jobs made about about $3B worth of mistakes (his ouster from Apple, Next’s limited success, and Pixar losing money for so long). This was, in effect, $3B worth of business lessons, knowledge and training that set him up for Apple’s resurgence in the 90s. Through it all, he maintained a maniacal belief in himself.
Before he died, he had a long conversation with Larry Page about focus. Lots of Google products have since been chopped.
He asked Aaron Sorkin to help him with his Stanford commencement speech. Sorkin never got back to him.
When John Mayer was 27, Jobs used to have him round for dinner regularly and considered him the best guitarist in the world.
“John Mayer is one of the best guitar players who’s ever lived, and I’m just afraid he’s blowing it big time … I think he’s a really good kid underneath, but he’s just been out of control.”
Through the Jobs lens, all companies, regardless of size, reflect their founders. Actually, this is one of the best parts of the book. Seeing Gates and Murdoch and Iger and Eisner and Ellison through Jobs’ prism of reference.
Apple’s design team worked on an ‘Applefied’ version of The Daily at the same time the News Corp team did. Jobs preferred the News Corp version.
On the night of his greatest success, the launch of the iPad, Jobs was depressed:
“As we gathered in his kitchen for dinner, he paced around the table calling up emails and web pages on his iPhone. I got about eight hundred email messages in the last twenty-four hours. Most of them are complaining. There’s no USB cord! There’s no this, no that. Some of them are like, “Fuck you, how can you do that?” I don’t usually write people back, but I replied, “Your parents would be so proud of how you turned out.” And some don’t like the iPad name, and on and on. I kind of got depressed today. It knocks you back a bit.”
The book is filled with so many amazing insights – Jobs’ two hour chat with Dylan, Jobs’ frequent crying, Jobs’ insufferable personality in his 20s, Jobs’ chats with Clinton and Obama, his relationship with Joan Baez and his unwillingness to soften or cede ground, even at his weakest.
Whatever you make of him personally, it was a truly amazing life.
With respect to healthcare, the next decade holds four inevitabilities:
People, on average, wil get unhealthier and we will see increased rates of obesity, diabetes and death through lifestyle-related disease.
The healthcare system will become less efficient as the boomers start to use up a greater proportion of healthcare resources. In the US, 25% of all Medicare spending is for the 5% of patients who are in their final year of life so as our parents’s generation starts moving into that phase of their lives, there will be an unprecedented drain on healthcare resources.
Governments will not be able to repair this inefficiency meaning the onus will shift back on to the individual to manage and improve their own health.
As the onus shifts back on to the individual, digital tools will become the primary means of individual healthcare management.
Within that context, many new business are emerging to provide digital health solutions.
Companies like Redbrick Health, Bloom Health, Limeade and others are engaging employees in health programs. One of my favourite products in the space, Runkeeper is building a Health Graph to aggregate all this new data in one place. Buster and Jen are building Health Month and bud.ge to help people change their behaviour for the better. Before he went and built Facebook’s new timeline, Nicholas Felton was helping people to beautify their data with Daytum. Massive Health just released The Eatery to get people eating healthier. Daily Feats are inspiring healthy behaviour through rewards and community support. Withings, Fitbit and Zeo have been leading the charge for #quantifiedselfers for a couple of years now.
The video above is a promo-piece from Ericsson, and it includes comments by Wired UK’s editor David Rowan identifying the power of sensors to change people’s health. With Wired Magazine fully bought in, this is a trend that is likely to take off in the mainstream media.
However, there’s some fundamental things that the hype is going to miss.
In a vacuum, your health data doesn’t change anything.
Data is just knowledge, which is a weak lever for behaviour change. If you have decided to make a change to your health, data will help, but it is just one helpful option among many.
Data doesn’t change your environment. It doesn’t give you a genuine social driver for change. It doesn’t strengthen your willpower. It doesn’t create a meaningful stick to make the change. And it doesn’t give you a clear path to achieve your goal.
My friend, let’s call him Johnny, had his first child recently. Johnny was 15kg overweight at the time but realised immediately he needed to protect his daughter’s future by taking better care of himself. And so, he set himself an end of year goal to lose the weight. Using meticulous data-tracking, he did and as a result, he’s a cheerleader for this new movement. However, a year later, after returning to life-as normal (or as normal as it can be with a baby daughter), he put the weight back on.
Occasionally he steps on to his Withings scale, but he knows he’s overweight, he doesn’t need to be auto-Tweeting it. He wants to start tracking his meals again, but he’s done that already and it doesn’t hold the same novelty it once did.
Data’s value decreases over time.
The same datapoint, whether it’s weight or sleep or stress, sent to you over and over eventually just piles up until it’s as meaningless as an inbox with 497 unread emails or a Google Reader with 1397 unread articles.
I have a friend who is bipolar. He meticulously tracks his mood so as to be aware of signals that he may be entering a high or low swing. This strategy was recommended to him by his doctor. The issue is, at the very point he most needs to input the data, just as his mood is plummeting or sky-rocketing, it’s already too late.
Just as taking photos of your food or counting your steps or measuring your heart rate may have some novelty value at first, at the very point you most need data it will desert you.
Because data is you. It relies on you for its value. And when you’re doing the wrong thing, you know it without needing the data point to back you up. In Mint’s early days, the biggest challenge they faced wasn’t getting people to trust them, it was getting people to log in when they knew their account balances weren’t going to tell a happy story.
This is data’s great challenge. Becoming something more than just an unread email. Becoming useful at the point it’s most needed.
When I walk around my neighbourhood on weekends, there’s often stoop sales happening. Almost without fail, in the pile of unsold items lies a fitness relic of some sort – Tae-bo videos, thighmasters, ab-crunchers. None of the people selling these relics look as though they ever gave them much use.
Health data is one crucial piece of the puzzle. But if we’re pinning all our hopes on it, then we’re likely to be disappointed. Healthy behaviour changes is a mixture of many elements, data being just one. If we miss this point, then health-data tools could end up like the stoop sale relics. Unused, still-new and full of false promise.
Slowly. Update: I received an email from The Australian’s editor Chris Mitchell explaining that sign-ups in the first 8 days had met their expectations (and to be fair, the numbers he shared were pretty good). He admitted the flow was cumbersome but reiterated how engaged users were with the paper across all platforms. +++ The [...]
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DB. I’ve been in a state of transition lately and under higher than usual levels of stress and pressure. About a month ago, I went a week without exercise. Reflecting on this, I realised how hypocritical it was. I think living healthier is the single biggest accelerator we could apply to improving society today. But here [...]
Every week from now until 2050, more than a million people will be added to the global ‘city’ population. In 2006 more than 50% of the world’s population was urbanised. This number will rise to 75% by 2050. Getting good at cities (GGAC) is a skill that’s going to matter more and more. It’s a [...]
