Steph Habif

Behavior

2011-10-05T07:47:00.000-07:00

As a behavior designer, I pay a lot of attention to what people do. While it is important to consider what people think, feel, perceive, and value, focusing on behavior (action) is one way to simplify our understanding of each other. You can learn what a person wants by observing his/her behavior. This observation is part of the design-thinking for behavior change.

Happen

2011-09-29T20:25:00.001-07:00

I am lucky to work everyday alongside a brilliant tech developer named John. Like me, John has an advanced degree in health care. Like me, John moved to San Francisco to work in the health 2.0 innovation space. Like me, John has a lot of ideas about how to make good things happen in health care.

Here's an example of the type of work we do:

A few weeks ago John started drumming up an idea for a Foursquare application. I think it's an idea he's had for a while, but the timing was right to pursue it. A veteran user of Foursquare, John introduced his concept to me and Tony - another brilliant tech developer - and together we three hashed out the conceptual design and strategy for what is now Fourhealth. It came to life thanks to a hackathon, which enabled John and Tony to build it. The idea is to help Foursquare users make healthier decisions about where they eat out. Ninety minutes after you check in to a restaurant, Fourhealth sends you a text message asking how you feel. This data is aggregated to the food venue, and along with objective user health data, provides ongoing feedback about how 'healthy' the decision is to eat there.

If you want to learn more, read here. If you want to try it, sign up here.

Not everybody uses Foursquare. But a lot of people do (~10 million users and 1 billion check-ins, to be precise). And effective health innovation should start with motivated users. The health 2.0 community cannot reach the unmotivated if we don't know whether or not what we've built is useful. Of course there are other dissemination strategies (and unlimited ideas) worth pursuing, but until this community produces something that truly impacts health care, we are all just a bunch of talkers.

In the wake of San Francisco's Health 2.0 conference, it is apparent that more than ever before we need to start walking more. The talent and energy is amazing. Let's make it happen.

How? For starters:

crystalize ideas
know who your ideas are for
identify and secure the talent you need to give life to those ideas
incentivize that talent
provide needed resources (money, space, food, etc.) to optimize talent
connect with your target community (know them)
establish that what you made works
make it better

What other ideas do you have for making it happen?

Mars

2011-09-20T09:08:00.000-07:00

"Men are from Mars, Women are from Venus" is a book about the drastically different ways men and women think, feel, behave, and function. I talked about this book over the weekend during a panel presentation at Medicine 2.0 along with my colleagues Ramin and Nic. ...because what we've learned over this past year from our health 2.0 collaboration is that entrepreneurs are from Mars and academics are from Venus.

We shared our insights, and specifically that in order to bring these two polar opposite industry experts together, certain elements are needed:

A method of connection. A strategist, social network, conference, or program must enable the partnership to happen.
Social pleasure. The people collaborating must like each other, especially when there is no defined process. When there is a defined process, it may not matter as much.
Alignment of interests. Cohesion happens when all parties share the same goal. Cohesion fuels innovation.
Clear incentives. In our case, Nic the academic wants data for dissemination of knowledge (publications and presentations). Ramin the entrepreneur wants data for credibility with industry partners and stakeholders.
A working agreement. A memorandum of understanding that outlines funding, role clarity, project design, and other factors to set clear expectations.
Trust. This is the most important element for collaboration. Nic the academic needs assurance that he can have wiggle room to satisfy a rigorous scientific process. Ramin the entrepreneur needs proof of experience to believe that the science being produced is of satisfactory quality. All parties involved need a moderator: someone good at communication and conflict resolution.

For more on this read John Abele's article on innovation in the medical field. Or even better, reach out to any one of us to chat more about health 2.0 collaboration processes.

Nic, Steph, Ramin

Innovators

2011-09-15T12:24:00.000-07:00

I moved to San Francisco on January 1, 2011 for two primary reasons:

1. To work alongside the largest critical mass of people in the U.S. doing effective health care innovation; and
2. To figure out how to translate what I know works - what I have learned in real life about effective health behavior change - to an affordable and scalable format.

I have found the greatest number of answers to "what works?" in BJ Fogg's Persuasive Tech Lab at Stanford. I am blessed to learn from him and collaborate with other members of those labs every week.

Outside of the Stanford labs, the innovation I am involved with and observing is summed up beautifully by John Schrom's latest blog post.

So just who are the people here doing health care innovation?

Tech Developers (like John Schrom):
-build things quickly = build first, strategize after;
-masters of many digital languages;
-sedentary.

Entrepreneurs (like Ramin Bastani):
-make antiquated processes obsolete to create new markets;
-idea launchers interested in what catches;
-sociable.

Academics (like Neema Moraveji):
-practice rigorous but slow processes for increasing new knowledge;
-thought pioneers who believe in the power of data;
-intellectual.

Venture Capitalists (like Elias Bizannes):
-informed and not sure how to evaluate innovations;
-creative and stealthy with money and meetings;
-opportunistic.

Business Developers (like Ed Liebowitz):
-value proposition and differentiation experts;
-ambitiously competitive and revenue producing visionaries;
-practical.

Health Clinicians (like Jay Parkinson):
-direct people providers with a landscape view of health care;
-dedicated to medicine outside of traditional practice;
-diagnostic.

*I just realized everyone on this list is a man. So last but not least, the ladies,

Designers (like Sara Butorac, Lucie Richter, Steph Habif, Elyse Marr, Shuquiao Song):
-use strategic methodologies to create beauty and fun;
-empathetics who capture the human condition; often dwell in concept.
-sensual.

These and many others are the bay area community of health innovators, and we all want to improve U.S. health care. We all come from different industries with different processes and speak different primary languages, so how can we define new processes that allow us to collaborate optimally? I'm very excited to speak about this on Sunday at Medicine 2.0.

Interdisciplinary

2011-08-13T15:12:00.000-07:00

I recently watched a talk that validated all the reasons mobile health and health technology should practice interdisciplinary collaboration. Some of the most important messages include:

commit to a worthy crusade
optimize innovation thinking by spending "a lot of time with providers, patients, and payors...to get really close really fast to issues/challenges to better understand root causes."
get in the field to do "intense observation"
learn how things really work (map and model)
hone problem solving skills
pursue best possible answer together
broaden the experience base of your team to maximize expertise
build in enough time to think and reflect to recognize important opportunities

Watch/Listen to Entrepreneurial Journey's in Health Care from Stanford University's eCorner.

Ethnography

2011-08-10T15:59:00.003-07:00

I had the pleasure of meeting with Chris McCarthy and Laura Janisse at Kaiser Permanente yesterday. They do ethnography and innovation consultancy at the Garfield Innovation Center. Chris showed me how they research, design, prototype, iterate, test, reiterate, test, reiterate....disseminate and evaluate solutions for patients, nurses, and doctors. It was the most impressive example of health care ethnography I've seen yet.

"Ethnography describes cultural systems or an aspect of culture based on fieldwork in which the investigator is immersed in the ongoing everyday activities of the designated community for the purpose of understanding the social context, relationships and processes relevant to the topic under consideration. Ethnographic inquiry focuses attention on beliefs, values, rituals, customs, and behaviors of individuals interacting within socioeconomic, religious, political and geographic environments."
-American Anthropological Association

Ethnography as a research method seeks to answer questions about human behavior; of living human beings in their environments. And it is critical for effective health behavior design.

How can we possibly design for health behavior change if we omit this piece of the puzzle? We can't. Designing for health behavior change without some sort of ethnographic evidence is like designing a shoe without knowing if the person who will wear it is male/female, heavy/light, young/old, rich/poor, going to be running/walking/hiking/jumping....it's like designing a shoe for a foot without knowing the foot size! May sound trite, but we must do everything we can to empathetically understand the particulars of our health care users.

This month I am doing an ethnography of people in 12-step programs (AA, Al-Anon, etc). I've studied, researched, taught, and coached people in AA and Weight Watchers. But I've never empathetically understood - until now. I hope.

Examples of innovation teams doing ethnography include:

Kaiser Permanente - Ethnography
IDEO - Human Factors
Stanford Design School - Empathy

Academia calls it a needs assessments or community based participatory research (CBPR).
Whatever you want to call it, dedicate time to capturing and understanding the people you are trying to reach. If we want our technology to connect with people, we must first learn how we as people can connect with people.

Disruptive

2011-08-03T12:53:00.007-07:00

"Reaching more people to provide behavioral intervention and support at less financial and personal costs requires 'disruptive innovation' in intervention design and delivery."

Yes!

I just read this published article on "Internet and mobile phone delivery vehicles for global diffusion" and while the topic was STD/HIV transmission, the authors raise several critical points that apply across all health behaviors:

Health behavior change is a dynamic process; and effective behavioral interventions are challenging to scale, which is why health technology developers and behavioral health experts need each other. Integrate behavior designers (and MDs and health educators and nurses and psychologists, etc.) into the development of health tech solutions.

Health is personal and social. People want to learn about their health in a personal, simple, social way. Mobile phones have quickly become one of the most personally relevant belongings in our society. Understand how people use their mobile devices - and what meaning/contextual relevance those devices have - and design behavioral interventions around that. Design around behaviors.

"Put hot triggers in the path of motivated people." Design, test, iterate, re-test, iterate....until you have something that works. Often "many crummy trials beat deep thinking." Well designed triggers delivered seamlessly into a person's daily living will optimize adoption of behavioral interventions.

Well designed technology based behavioral interventions can be as effective as human-delivered interventions.

A huge thank you to the founder of Qpid.me for this.

Laughter

2011-08-01T09:33:00.000-07:00

The power of laughter is limitless.

I was on an airplane yesterday flying back to San Fran from New York. Long flight; and the plane was packed. Not a single empty seat. I sat next to a very large and lovely man, so super squished- I was. These flying scenarios are stressful; forget about the physiological stressors that come along with flying, but then the social, environmental, and mental stressors make it even harder.

I was uncomfortable and unhappy.

And then I watched this video The Miracle Of Flight

Painful

2011-07-19T07:48:00.001-07:00

We are working on a pain management solution at the Calming Tech Lab.

Why?

Because

Learn more about pain in America in this NY Times article.

Persuasion

2011-07-06T13:58:00.013-07:00

Designing for persuasion is an exciting and challenging task. BJ Fogg is constantly refining his persuasive design process, and as members of his Persuasive Tech Lab, we have opportunities to practice this methodology. Always best to do this persuasive design process with a team that knows your target users. I use this methodology for projects related to habit design and health behavior change.

For example, let's say you want to design a solution to prevent the onset of Type II diabetes. [While this is a really big goal, many teams are working to address diabetes in America, so we'll go with it]. I would use the following process (see below for my whiteboard exercise and IRL user testing example):

1. State your Goal: "to prevent the onset of type II diabetes in adults."

2. Pinpoint Behaviors: generate a list of simple behaviors to change.
"Increase number of minutes of daily exercise; decrease amount of sugar consumption; increase number of steps walked per day; decrease amount of daily bread consumption."
*Consult the Behavior Grid and use the Behavior Wizard to specify behaviors according to size and time span.

3. Map Priority Behaviors: Identify target behaviors according to importance [level of impact = how vital is the behavior to attaining the health goal?] and feasibility [ability to perform the behavior = how difficult is it to create motivation?].
*Focus on the behaviors that will have the highest impact and will be the easiest to perform.

4. Trigger the Behavior: select the smallest behavior that matters ["eat one piece of bread per day"] and outline possible behavior sequences ["receive 'bread check' text message;" "respond to text about bread consumption."]. Be sure to put the behavior in terms of user actions. Only one of these sequences needs to work for success.
*Identify the channels that allow for easy tracking.

5. Test: Run crummy trials, iterate, retest. Only one needs to work, and if it works, grow it.

Cold

2011-06-17T21:07:00.000-07:00

Designing the fridge for getting over a cold.

Optional

2011-06-13T12:18:00.000-07:00

"Pain is inevitable; Suffering is optional."

A brilliant psychologist said this earlier today, and it resonated strongly with me. She was discussing her work using mindful-based meditation strategies with individuals who suffer from tinnitus. She just completed a pilot study as UCSF to better understand uses of meditation for tinnitus sufferers, because there is no cure for tinnitus.

Meditation-based coping is one of my primary interests. In particular, how can we design for effective daily coping habits for adults suffering from athletic injury. As BJ Fogg would say, how can we "put hot triggers in the path of motivated people?" Or as David Sobel would say, how can we "infuse the right solutions into the patient care path?" What do injured adult athletes need to minimize suffering and maximize coping?

This is what I am working on as part of the new Calming Technology Lab at Stanford. Designing calming technology is the brain-child of Neema Moraveji and I am thrilled to be a member of this innovative team. We spend our time prototyping and iterating tech-based solutions that increase calm in people's lives. My goal is to design something useful for injured athletes so suffering is the least of options.

Replacement

2011-06-04T08:09:00.004-07:00

I had an incredibly stressful week. It was one of those weeks that began with devastation. Events in my personal life left me feeling sad, scared, angry, frustrated, and defeated. We've all been there.

Sometimes it's hard to get out of bed when you feel that hurt. When you're that devastated, you don't have the care nor energy to take care of yourself. There is a very fine line between staying functional and ending up stuck on the couch with ice cream and bottle of wine. In an instant, your health disappears.

Every time I felt myself crossing that line this week, I tried something different. Habit replacement.

Here's what I mean:

On Tuesday, as I sat in a work meeting at the end of the day, all I could think about was having a drink. Anything to calm me down. My mind was racing. I was barely holding it together. I didn't trust myself (ever had that experience?). So instead of being alone that evening, I called a good friend before leaving the meeting. A friend who I knew would make me laugh. We went for sushi and a drink. But just one drink, and at the end of the night, he made sure I arrived home safe. Instead of drinking alone, I ate and drank with a good friend.

Wednesday I was working at home. I kept tearing up, and all I wanted to do was crawl into bed. I couldn't focus. Facing a work deadline, I packed up and went to work at a cafe. A local place where I knew many others would be working too. Two guys were sitting near me, and they kept laughing. It was awesome, it made me want to laugh. I remembered a video my brother once shared with me that made me laugh so hard I nearly peed, so I watched it. I channelled that energy into my work, and was super productive. Instead of working at home, I went to a cafe. Instead of focusing on sadness, I focused on laughter.

My Thursday schedule wasn't due to start until lunch time. Worried I wouldn't get out of bed until I "had" to, I planned an early morning hike. Instead of laying in bed, I exercised.

As I was working at home on Friday afternoon, I felt my throat tighten. Even though I had been working well all day, I started feeling anxiety in my jaw...I had a hard time breathing. I took deep breaths. I tried to relax my throat, but couldn't. So I poured a glass of red wine. Sipping while I worked, one glass soon turned into two. I was happily fuzzy in my head, but my throat hadn't really relaxed. I wanted another glass of wine, but instead, I went to a yoga class. I could breathe freely by the end of class.

I used health habits to keep myself on the healthy side of the line. Like Nike says, Just Do it. Sometimes you have to fake it 'til you make it. Each day I feel a bit more resilient. Habit replacement is empowering.

Coping

2011-06-01T12:19:00.003-07:00

I wrote an article about coping with injury for the Crossfit & endurance communities. In that article, I offered a list of strategies for healthy coping: cultivate a positive attitude, eat anti-inflammatory foods, follow rehab protocols with discipline, etc. These are 'big picture' strategies. But when it comes to coping, what is the smallest behavior that matters?

Targeting the smallest behavior that matters is a critical design principle for effective Behavior Design. When someone is injured, it's not enough to say "eat anti-inflammatory foods." Because what does that mean? How do you do that? So how can we better design coping?

In the case of athletic injuries, consider the following examples:

"Eat anti-inflammatory foods" means

eat a handful of blueberries in the afternoon
replace morning bagel with bowl of oatmeal
add a tbsp. of cinnamon powder to your cup of coffee
take fish oil supplements before 12 noon and after 6pm.

"Cultivate a positive attitude" means

watch a funny show every night before bed
text one thing you are grateful for to a friend before breakfast
write down what part of your body is working after you bathe
before you get out of bed, choose a positive theme for the day

If you can do just one, small daily habit that matters, you are already coping more effectively.

I'm working on a mobile technology solution to increase calming among injured athletes for better coping. Playing around with what that will look like.....

Data

2011-05-22T23:16:00.092-07:00

I love Jay Parkinson's blog.
In one of his recent posts he wrote, "data doesn't change behavior":

Does data change behavior?

Data is information, and information (if consumable) increases knowledge. Knowledge alone does not change behavior. The classic public health equation is K + A = B (Knowledge + Attitude = Behavior). Of course, it's not that simple.

I decided to randomly ask a few people (friends of mine, not colleagues) in San Francisco, "do you believe data changes health behavior?"

Person A. Adult female, Type 1 diabetic, chiropractor.
"Data absolutely changes behavior. Any time I see a number indicating my blood glucose levels, I make decisions about my diet, insulin pump, etc. I need that data to stay alive and live well......"
Answer: Yes.

Person B. Adult female, disease free, self-declared obsessive compulsive.
"Data sometimes influences my health decisions....if I'm just reading an article about a new health study, or if I find out a food I like has too much fat, I probably won't change my behavior.....if I weigh myself and notice that I'm losing weight, I try to understand what is at the source of my stress and make changes. Because anytime I lose weight, it's because my stress levels are too high......"
Answer: Sometimes.

Person C. Adult male, recovered addict (sober 3+ years), full-time student.
"Data can change behavior for sure....I think there are two categories of behavior: satisfaction-based and fear-based. Most Americans try to do fear-based behavior change - meaning, they try to quit smoking because they are afraid to get cancer, or they go to the gym because they are afraid to get fat. Fear-based behavior change is high on the motivation scale but low on the sustainability scale. So data for those people triggers them to change in the short term. Satisfaction-based behavior means going for a run because you enjoy running, or cooking health meals because you love the taste of healthy food.....athletes are an example of satisfaction-based behavior change makers. For them, data absolutely will change their behavior, if they want to get stronger or faster.....satisfaction-based behavior change is high on the motivation scale and high on the sustainability scale...."
Answer: It depends.

Person D. Adult female (that's all I know about her).
"Data can change behavior if a person seeks out the data. Anyone seeking specific health information is already motivated, so most likely they want to change, and knowing on a regular basis what their data says will help with sustain that motivation....."
Answer: Yes.

Data alone may not change long-term behavior, but if designed right and placed into a meaningful context, data can change behavior. Who is receiving what data when? Understand the psychology of your consumers before you deliver data. And be very clear about what you want them to do with the data.

Chemistry

2011-05-16T08:18:00.002-07:00

I was miserable when I woke up this morning. I felt exhausted, anxious, and wanting nothing more than to go back to bed. My attitude was exactly that of my friend Nic: "Screw you, Monday morning!"

Going back to bed wasn't an option, though. So I made some coffee, turned on my computer, and started the day. As I worked, I became crankier, more anxious, and then started feeling sick to my stomach.

So you know what I did? I went to the gym.

I went the gym because it was the only hope I had for redesigning my attitude. I walked in, got on a stationary bike, and started pedaling. Not too fast. Not too hard. Just pedaling. One after the other. And slowly, I started feeling a shift. My body was warming up; my mind began thinking clearly; and my energy was starting to flow.

Exercising this morning was not about weight loss. It was not about vanity. It was about chemistry. I needed to change the chemistry of my mind/body/spirit. I didn't have the energy to run or do yoga...I had just enough energy to push pedals on a stationary bike.

I didn't even notice how long I'd been pedaling until I looked down and saw 45 minutes on the timer. For anyone who knows, pedaling 8.77 miles in 45 minutes is not fast. It's not even kind of fast. But that doesn't matter. What matters is that while I was exercising, I was thinking about changing my chemistry.

Now I feel better.

As Covert Bailey said, "I had a big fight with my wife, and boy, was I angry. So I went out to run. Within 15 minutes, I forgot what we fought about. Within 30 minutes, I forgot that we fought. By the time I finished running, I forgot I was married."

MH11

2011-05-11T14:37:00.000-07:00

As if the Mobile Health 2011 conference wasn't fantastic enough, the follow-up blog posts, tweets, and overall collective conversation has been just as fun.

For really great reviews (and I am sure there are others and there will be others), search Twitter #mh11. Some of my faves come from @textinthecityNY, @andrewpwilson, @msaxolotl, @geoffclapp, @kevinclauson, and @chiefmaven.

From my corner, I want to continue the conversation where it left off IRL, as asked by BJ: "What surprised you?" and "What would you like to see next year?" How great that he invited attendees up to the stage to share their perspectives on this. I responded to "What surprised you?" with "How wonderfully easy it was for us all to communicate with each other."  

MH11 enabled different people (researchers, patients, c-level executives, designers, entrepreneurs, investors, community leaders, students, innovators) from different industries (public health, academia, government, technology, health care, social media, entertainment, advertising, insurance) to come together and communicate. Collaboration between industries is not often easy, because we have different processes, attitudes, languages, and cultures. Mobile health is a beautiful blend of industries - it is a surging new field with limitless potential that requires ongoing collaboration.  

The collective participation of technologists, researchers, practitioners, patients, and so on is needed for effective health behavior change design. Not because behavior change is hard (BJ contends behavior change is not so hard when you have the right process, which is a primary focus of his Persuasive Technology Lab), but because it is dynamic and multidimensional. We are just starting to understand how to design for it well. Or are we?  

Academia produces quality evidence but it takes too long. 
Government produces quality evidence but suffers from a severe lack of resource. 
Technology produces quality evidence but misses the meaningful intricacies.
Healthcare produces quality evidence but is stifled by restrictions.

Mobile health is ripe for a new process that will foster collaboration and produce quality evidence to satisfy all industries. In the meantime, we must be out there doing the work.  

As we do the work, consider #mhealth process opportunities: 

Rock Health and other incubators that bring together industries (like RWJ Pioneer). 
Medicine 2.0 and other conferences that foster collective learning (like Mayo Transform 2011). 
Nation Builder and other internet spaces that build group support (like Twitter).
Habit Design and other Meetup groups that enable networking (like Quantified Self).

And of course Stanford Mobile Health conferences. Easily one of the best solutions for fostering collaboration and advancing the field.

Qpid.me CEO/Founder Ramin Bastani and me at MH11

Triggers

2011-04-17T09:25:00.003-07:00

When designing for behavior change, Dr. BJ Fogg, Director of the Stanford Behavior Design Lab, says "Put hot triggers in the path of motivated people." This is the primary tenet of the Fogg Behavior Model.

But what exactly does this mean? What is a hot trigger?

A trigger word is a very popular performance psychology technique = we teach athletes to use trigger words to better regulate their emotion and energy for peak performance. A trigger for behavior change, though, can be more than a word. It can be anything. Anything that tells you to do it now.

During a work meeting at Stanford a few weeks ago, BJ said "Let's say you want to eat more fruits and vegetables....what is the one thing that will trigger you to do that? Do you need to see them in your fridge? Do you need a daily reminder in your IPhone.....?"

What he means is, how can you design your environment for healthier habits?

I've been thinking a lot about the fruits and vegetables conversation. I am very guilty of letting the fruit in my fridge go to waste. I see it every time I open the fridge. But why don't I eat it? What is the hot trigger missing?

This is what the strawberries in my fridge usually look like:

In can see the strawberries in their container; and I placed them front and center. But that still doesn't trigger me to eat them. Is it really that hard to take strawberries out of their container, rinse and cut them?

So I decided to design the strawberries in my fridge. I prepared them ready to eat, and now I see this in my when I open the door:

Happy to report regular consumption of strawberries over these last two weeks. Not a single berry has gone to waste.

Stories

2011-04-07T09:08:00.005-07:00

I just spent a few days at the Human Performance Institute. It was a thrill to be there because I've been following the work of HPI founder, Dr. Jim Loehr, my entire career. He is sport psychologist who figured out how to package and deliver performance enhancement strategies to corporate executives.

One of the primary offerings at HPI is a 2+ day intensive Corporate Athlete Course in which they contend energy management - not time management - is the key to being happier and healthier professionally and personally. HPI coaches teach clients to make significant changes by utilizing an arsenal of nutrition and exercise strategies such as:

Eat light and eat often;
Be sure your diet is comprised of 80% "need" foods and 20% "want" foods;
Do interval training at least two times per week;
Carry a resistance band in your briefcase so you can train in an office, airplane, or hotel room if need be.

These strategies are nothing new. What's great about HPI, however, is that they place these behavior change strategies in the context of evidence-based, holistic, performance psychology models.

For instance, self-talk is a popular strategy used in the world of sport for peak performance. HPI coaches challenge clients to recognize their self-talk. "When you're constantly working late at the office...when you're with your kids but working on your blackberry....when you tell yourself you don't have time to exercise.....what is your justification? What are you saying to yourself to validate these types of behaviors? What's your story?"

Stories are HPI's version of self-talk. Stories are what we tell ourselves to justify unhealthy behaviors. We all have stories:

"We were members of the clean-plate-club in my family, so now I feel guilty when I don't finish an entire meal."
"If I leave to exercise my boss will think I have nothing else to do."
"I deserve a cocktail after working so hard."
"My father taught me to work hard, play hard."
"If I want to socialize with my friends, I have to go out and drink with them."
"A bowl of ice cream every night helps me unwind from the day."

Where do your unhealthy habits come from? Why are they a part of your daily living? The answers to these questions reveal your story.

I eat too much. My old story is that I eat too much because "I'm stressed; I don't have time to eat; we always ate so fast in my family; I'm a bad person if I waste my food......" Now each time I eat, I think about my new story.

In order to effectively change behavior, we must know our stories and we must want to rewrite them.

Trend: A Big Gap

2011-04-03T05:55:00.002-07:00

After two stimulating days at the Sex:Tech 2011 conference, I want to comment on a recurring theme (that has emerged at large, not just at this conference).

One of the panels discussed the gap between the public and private sectors and how much of a challenge it presents in advancing the health field. Many thanks to panel members [Yin Ling Leung, Amanda Mills, Dr. Jody Ranck, and Dr. Robyn Whittaker] for sharing their insights during the MHealth Panel (check out the full panel session video)

What is mhealth?
"Delivery of health care services via mobile devices"

What do you see happening (what needs to happen) in mhealth over the next year?

"To empower and help the end user... mobile apps need to be connected (to a system, program, community) and work across all platforms."
"The mobile device (not the desktop computer) will soon be the primary method of accessing the internet"
"Messaging is going to be really important in reaching traditionally underserved populations....but messaging doesn't need to be boring..."
"A lot more behavior change & data collection using mobile phones is coming...."
"The real game changer.....is this area called 'open architecture'....to use data more effectively....to allow us to use mobile devices to change the landscape of public health...

Trends: connection/connectivity; reach; interactivity; behavior; data; open architecture.

What are the most prevalent issues we're facing in mhealth?

"One of the biggest barriers [to advancement] is public health as a discipline. ...public health and academia are not producing the types of professionals needed...they don't know anything about design, they don't know how to do business plans, they cannot serve as a diplomat to navigate in between the public and private sector...and they must know how to negotiate...the field of public health needs to change to catch up...it's a very big problem in the field."
"If you're trying to merge public health objectives with new technologies it can be incredibly challenging."

Trend: we must find a way to enable the public and private health sectors to communicate and collaborate!

When trying to rollout mass media projects, what strategies do you employ?

"We use text messaging a lot as a cross platform...and we work constantly with the carriers...we use messaging as the hook to move users into richer products."
"Behavior change strategies: people have to feel like they are on the path to better behaviors and then mhealth can move them along that path."
"We don't know a lot about how to do this well (design for behavior change)...there's not a lot written...there's a lot of people doing a little bit here and there, but there is not a good knowledge base or a way of sharing what is working for whom...I encourage people to build evaluation into what you're doing and publish so we can all learn from it...we need more partnerships...partner with researchers that have experience ...in order to do the process well...."
"The current system - the current infrastructure is a barrier...."
"HIPPA prevents getting data into the hands of end-users...it stifles innovation..."
"We must design to scale. We are building networking tools, but we don't have a networking system. We need (mobile health) ethnographic data."
"Do focus groups and formative data collection with priority users at the start to better understand what your audience needs, how they will use it, what theories of behavior change emerge....which takes time to do!"
"Learn from simple and scale-able programs (e.g. text4baby)."
"Stand alone/apps in silo's do not work! Must be connected to a doctor, group, system."

Trends: we haven't yet figured out how to design for behavior change; our system stifles innovation; we need to integrate research strategies into design development; network not just your technology, but your organizations; know your end-users before your design and disseminate; build it to scale; keep it simple!

As a professional, I felt so incredibly validated listening to this panel! This is why I moved to San Francisco. This is why I left full-time academia. This is why I have been on a crash course to learn tech/design speak, skills, etc. This is what I dedicate every single work hour to = how can I, a health behaviorist with over a decade of academic and practical training, be useful to health tech and design teams?

How can I - how can we - be better at bridging the wide gap between the public and private sectors?

Flying

2011-03-29T13:48:00.001-07:00

I'm flying to the East coast today for important work meetings tomorrow morning. I need to bring my A-game, which means I need to think clearly, look good, and feel good! But anytime I eat airplane food, I'm left feeling lethargic, dissatisfied and bloated. Mainly because airplane food is packed with calories, salt & sugar (preservatives), and unhealthy fats. So as part of my meeting prep, I packed a lunchbox for the plane: sliced turkey, carrots, banana, dry roasted almonds, blueberries, and water. Easy to pack, easy to eat, and economical!

I also get nervous when a flight full of people are coughing and sneezing. It seems fairly easy to pick up a respiratory bug on an airplane. Essential Oils (Theives) and anti-bacterial creams applied to the nose and throat are good strategies for protecting against the in-flight toxins. High doses of Vitamin C before and during airplane travel can help boost immunity too.

Early this morning I went to the gym to do a 40 minute moderate intensity workout. I ate a healthy breakfast and took some Vitamin C before I left for the airport. And just prior to boarding, I sprayed Thieves on my hands and face. Tonight I will take 500 mg of Melatonin to optimize my sleep in hopes of minimal jetlag effects (don't want puffy eyes!)

Is there anything else I can do to boost my health during transatlantic travel?

Perhaps none of this makes much of a difference in the end, but if I think it does - if I am empowered by my behavior - then I say, welcome the placebo! Ready to rock it tomorrow!

Include Health Behaviorists

2011-03-16T08:59:00.003-07:00

From Jay Parkinson's blog

This is a hot topic. Many brilliant bloggers like Jay and Erica Holt have been writing about mobile app efficacy. Apps can certainly be part of a health behavior change solution. But health does not happen in silo's.

Health behavior change requires more than one strategy. With the surge of mobile health applications and wellness design innovation comes a growing need for behavioral health researchers and practitioners. A clear understanding of health behavior science is key for optimal design, implementation, and usability of products, programs, and services. Very few design teams and organizations are using behavioral health experts, leaving an important gap in the development process, Ultimately, behavioral health experts are well equipped to contribute to this growing body of work by collaborating with designers and entrepreneurs.

That's why I'm working with Ramin Bastani - Founder/CEO of Qpid.me. He gets it. And Jeff Halevy of Halvey Life. He gets it. These entrepreneurs see the value in including a behavioral health expert in their concepting and design processes. The guys at the Future Well are awesome at this. And of course, Dr. BJ Fogg at Stanford is leading the charge to advocate for health behavior change science integration in the worlds of health technology and wellness design.

Learn how to ask important questions before you design and disseminate. Tap into behavioral health expertise to formulate your methodology. Get a grip on the process of health behavior change if you're designing for health behavior change!

Epigenetics

2011-03-13T11:47:00.001-07:00

The topic of epigenetics came up during a conversation today with a very brilliant physician. As I was listening to him speak, I started thinking about the implications of epigenetics for health behavior change. And then I found a Time magazine article that comprehensively explains to power of these genetic insights. Here's a health behaviorists take on epigenetics:

"At its most basic, epigenetics is the study of changes in gene activity that do not involve alterations to the genetic code but still get passed down to at least one successive generation. These patterns of gene expression are governed by the cellular material — the epigenome — that sits on top of the genome, just outside it (hence the prefix epi-, which means above). It is these epigenetic "marks" that tell your genes to switch on or off, to speak loudly or whisper. It is through epigenetic marks that environmental factors like diet, stress and prenatal nutrition can make an imprint on genes that is passed from one generation to the next."

Our environment influences the nuclei of our cells, works on the DNA, and turns on and off certain genes to drive certain behaviors.

"There's evidence that lifestyle choices like smoking and eating too much can change the epigenetic marks atop your DNA in ways that cause the genes for obesity to express themselves too strongly and the genes for longevity to express themselves too weakly. We all know that you can truncate your own life if you smoke or overeat, but it's becoming clear that those same bad behaviors can also predispose your kids — before they are even conceived — to disease and early death."

"It's important to remember that epigenetics isn't evolution. It doesn't change DNA. Epigenetic changes represent a biological response to an environmental stressor."

Unhealthy behaviors - at the most basic cellular level - can quickly lead to "genetic diseases." This is a two way street: health behaviors prevent disease, prolong longevity, and fortify stronger genes. Not just for us, but for our kids and grandkids, and great grandkids.

Standing

2011-03-11T09:41:00.001-08:00

My legs were sore when I woke up this morning. I couldn't figure out why; I haven't done any exercises out of the ordinary. And then I realized: I'm coming to the end of my first full week using a standing desk! Yep, as I continue to set up my new place in San Francisco, I chose to set up my "office" with a standing work station.

It's not my first time using a standing work station. But at my last place, the work station was built in. I've never had to design my own. Where to go to buy a standing work desk?

The Genius Bar at Apple is designed for standing work.

Jay Parkinson advocates for standing desks - so I e-mailed him.

I even walked through an entire IKEA to come up with some ideas. Then, two weeks ago as I was staring at this empty bookcase my grandfather made, I thought "hey, that could work!"

I took the measurements and in fact, the top shelf meets my height requirements well enough.
The piece is 47 in. high; 36 in wide; 10 in. deep.

I strategically placed it to allow the surrounding space to enhance my work. I like to be inspired by environment, so:

Natural light on both sides
A magnificent view to my left
Flowers and plants on my right to tease my senses of smell and sight

*I'm contemplating a rubber mat on the floor where I stand - or a really good pair of "work sneakers" to prevent foot fatigue.

Some people work better with no distraction. They need no or minimal stimulation to produce their best work. We are all unique when it comes to optimizing productivity. I think best on my feet.

So far, I am loving my new work station! It's such an economical option. Not to mention the added benefits of mindlessly burning more calories and preventing disease.

Tips for setting up your own standing work space:

consider your height so your computer set up allows for good posture;
protect your feet with quality shoes or a friendly standing surface;
ease in - if you've never spent hours per day standing, spend just an hour or two at first and build up our time standing to allow your joints and muscles to adapt;
create your ideal working energy - do you work better with some environmental distraction or do you need total focus?
be proud. We were built to stand!

ExeriseORDiet?

2011-03-07T07:45:00.003-08:00

It's certainly not the first time I've addressed this question, but it just came across my desk again yesterday:

Hey Steph,

I need to crowd-source an expert opinion on a discussion I was having recently, and thought you might be the perfect person to provide just a sentence or two of judgment.

Scientifically speaking, which has a more important and more definitive impact on long-term physical and mental health: exercise or diet? Put differently, which population would live a healthier life longer: perfect diet + totally sedentary lifestyle, or perfect exercise regimen + donuts, bacon and soda diet? Also, is science clear about the answer, or is there a lot of room for debate?

I'm not looking for citations or a nuanced explanation, just a few words that summarize your total view.

How would you respond?

Egypt

2011-02-10T14:18:00.001-08:00

Morris Panner wrote an excellent commentary on the power of the technology to trigger change in Egypt.

First, I pray that the people in Egypt stay as safe as possible during this time of unrest.

Second, I very much agree with his comments about the power of the internet and the fact that it is influencing behaviors (dating behaviors, communication behaviors, etc, etc.); for better or worse we don't know yet.

As a behaviorist, I am always careful to state that I believe technology is part - potentially a crucial part - of the solution for health behavior change (not the sole solution). However, Egypt is a convincing example of how technology can enable and motivate the masses behaviorally - so what are the MOST important lessons to take away from what is happening in Egypt re: using technology for health behavior change? Can we start a coup against the fast food industry? Can we generate an uprising against the US health insurance industry to demand greater access to health care? Can we use Twitter to make exercise more "trendy?" How can we cultivate the wisdom from Egypt and apply it to our greatest health challenges here in the US? That, to me, is an exciting question!

Sell

2011-01-26T09:37:00.004-08:00

President Obama called for more innovation in health, education, and technology during his State of the Union speech last night. The day before, I listened to an innovator - an entrepreneur here in San Francisco - tell his experience with a health care innovation project. He's no longer working on that project, but instead is at the helm of a start-up adventure travel company. As he said, "It's not as hard to sell adventure travel.....how the heck do you sell health well?"

Our health care system (being so broken) is certainly ripe for innovation. And boy, do we need it! We hear every day of thousands of Americans being denied health insurance (including me). Lifestyle diseases surrounded by poor diet, little physical activity, lack of adherence to medications, lack of access to good doctors, etc. are driving health care costs to the stratosphere. Forget about the monetary cost - we are unhealthy and unhappy.

So why is health so difficult to sell?

Part of what makes health a hard sell right now is that Americans are turned off by the health care system. In a major way! Such negative attitudes mean that perhaps the health care system (as it exists) is not the right entity to sell health. Another difficulty is that we are a sick nation. We do not value health, often until it's gone, and even then, sometimes the worse a person feels, the less s/he wants to get better. Thirdly, we as patients/consumers do not understand health very well - it has become so confusing! Lastly, many of the folks innovating health care solutions leave out health behaviorists, health educators, and clinical health care providers who can share insights on they way people do health.

So the gap between the sellers and the buyers is widening.

We need a health renaissance in this country.

Part of that renaissance is happening with health technology. Brilliant designers, engineers, entrepreneurs, and business strategy minds are trying to innovate effective health care solutions. Technology enables fast and cost-effective delivery, sure; but in order for technology to impact a person's health and happiness, it must meet the person where s/he is at. Meaning, technology must deliver to the user exactly what s/he needs in the way s/he he wants to receive. Engaging in health is a process, not an outcome. Health behavior change rarely works when we sell the outcome; how can we better at selling the process?

Selling the process of health behavior change requires experts who have expertise in health behavior science. How else can health tech companies ensure they are designing solutions that will work? Health tech solutions must effectively educate, increase self-efficacy, and provide social support. Like Facebook, if health is socially enjoyable, people will use it. That's one of the reasons Crossfit and triathlon (to name a few examples) have become so popular. These two fitness communities cultivate strong social ties and specific identities. Identities that participants pride themselves on. Can health tech create a similar experience?

Selling health also requires a kick-ass brand. Health practitioners do not know how to brand health, so design agencies must be better at understanding health. And health consumers must be better at demanding what they need. There must be an ongoing dialogue between patients, providers, designers, and innovators. At the forefront of this concept is The Future Well.

So the renaissance IS happening :)

Other real-life examples include:

BJ Fogg
IDEO
qpid.me
MDVIP
Patients like Me
Health 2.0

Health behaviorists and educators are in a unique position to facilitate the dialogue necessary to continue the renaissance. I am attending the Health 2.0 Developer Challenge this weekend to gain a better understanding of the renaissance, because I want to share my skills and expertise with people leading it!

Courage

2011-01-17T13:48:00.000-08:00

Today is a great day to reflect on courage.
It takes courage to pursue genuine happiness. It takes courage to experience change.
Life change takes courage; health behavior change takes courage.

Bring courage to your self and your life. Breathe; listen to your heart. Be steady and strong. Couragious!

Resolution

2011-01-05T19:53:00.000-08:00

'Tis the season for resolutions, and I wonder what yours are? Do you have more than one? And do you think about making positive changes in your life at other times of the year, or just when a new one comes?

A new friend told me a story about breaking up recently. As I was listening, I thought, "wow, this person is dedicated to genuine health and happiness." Genuine health and happiness requires courage, patience, self-love, and a willingness to accept ourselves as human beings. We are not perfect, we are human, and that's even more interesting.

Several brilliant minds are dedicated to the ongoing study of health and happiness. What I believe their greatest strength to be, as practitioners, is to communicate the pursuit of happiness with simplicity and practicality. So before you declare a resolution you will not keep, consider the basic resolution to be happier.

Check these guys out:

Jay Parkinson

Tal Ben Shahar

Alex Lickerman

HolidayExercise

2010-12-20T05:29:00.000-08:00

Aside from all the wonderful things regular exercise does for our mind/body/spirit, exercise during this time of year can increase our energy, boost our immunity, help us think clearly, and promote better management of holiday specific stress. It doesn't take much.

Be strategic with your exercise. Think of exercise as a dose, depending on what you need help with.

Challenge: too fatigued.
Solution: low-intensity exercise.

Challenge: feeling sick/have a cold.
Solution: moderate exercise.

Challenge: can't think clearly.
Solution: short bursts of intense exercise.

Challenge: too much stress.
Solution: any kind of exercise.

Moving

2010-12-07T13:52:00.000-08:00

Is there anyone out there for which whom moving house is not a stressor? As I pack up boxes and manage the uncanny number of logistics related to leaving my house next week, I'm baffled at how draining the process is! I have less and less energy for the other parts of my life as I close in on our closing date.

Two weeks ago, I was allowing my moving stress to get the best of me: eating and sleeping like crap; not exercising; drinking alcohol to relax...and then I had a moment of clarity in which I realized that I was letting the process of moving control my health and happiness. Why? Why not find ways to better manage the stress?

So I started committing to daily early morning workout sessions at the gym. Sometimes I'm there for 10 minutes and sometimes I'm there for 2 hours; as long as I break a sweat, I'm good. I use imagery to imagine the toxins and stressor leaving my body in the form of sweat. I listen to therapuetic music while I'm working out.

I gave up refined sugar. Why? Especially during the holiday season, why would anyone give up sugar? Well, I thought about what I do and don't have control over right now. Of course, I can have control over what I eat and drink. ...if I choose to. So no refined sugar (I decided this would be a heck of a challenge for me) and only limited amounts of vodka.

I wake up every morning no later than 6.00am; which means I'm flat out exhausted by the time my head hits the pillow and I don't even remember falling asleep.

I decided to use small habits to better manage my moving stress.

I still have weeks of moving stress to endure. I've decided to cope, though, with a small arsenal of healthy habits that are helping me feel empowered rather than helpless.

Loss

2010-12-01T11:58:00.000-08:00

One of my childhood friends died yesterday in a tragic accident. He was 35 years old - a husband, father, son, and friend to many. When I received the news this morning, I stopped breathing for a minute. I couldn't believe it. And suddenly, I felt so sad. So sad for his family, so sad for his friends, so sad for the loss of him.

Losing someone is an experience we can all share. Whether you lose due to death, divorce, or breakup, the emotional pain is inevitable. How we deal with it is as unique as each of us, and there's no right or wrong way.

Some of the best support I know of for this comes from:

Hold the Door for Others
When Things Fall Apart
It's Called a Breakup Because It's Broken

Thanksgiving

2010-11-26T05:08:00.005-08:00

Before eating the feast, each person at our Thanksgiving dinner table took a moment to say what they are thankful for. Here's some of what I heard:

"I'm thankful for the love of my life and my beautiful daughter."

"I'm thankful for health and longevity."

"I'm thankful for clean air and water."

"I'm thankful for my kids."

"I'm thankful for all this amazing food"

"I"m thankful for old friends and new family."

"I'm thankful that we can vote - how 'about those Republicans, eh?"

"I'm thankful for health and happiness"

We are so lucky.

Many places exist here in the United States and around the world where there is no clean water, no quality food, lack of free government, and little happiness.

Thanksgiving may have been yesterday, but today I am just as thankful.

Walking

2010-11-18T11:20:00.000-08:00

My niece, Skylar, is four months old. She is so excited to crawl and walk! She loves to stand on two legs and work on putting one foot in front of the other.

We don't do that very much as adults. Walk, I mean. We've engineered walking right out of our daily lifestyle - elevators, cars, subway trains, etc. We don't need to walk to get most places, do we? So why walk?

Because it is what our human bodies are made for. We are built for walking. We evolved to walk. It feels good to walk. Bob Hope lived until age 100, and he consistently went out and took a walk every day. Everyday! And there's even great news for shorter humans: Shorter people burn more calories walking than their taller friends. Which means Skylar is going to be much thinner than her auntie after we finish walking across the room.

Headache!

2010-11-08T06:59:00.001-08:00

I ended up in bed last Thursday with a migraine headache. I was so debilitated, all I could do was lay in bed in a dark, quiet room and breathe until it was over. It was awful. I've had an ever-so slight residual headache since that doesn't want to go away. Argh!

Sound familiar? Anyone who has ever experienced brain pain knows a headache. Why does this happen?

Stress

Bright Lights

Change in Sleep or Poor Sleep

Medications

Changes in Weather

Two biggest Triggers:

Hormones

Food....specifically chocolate, coffee, aged cheeses, and alcohol (especially red wine). **My top 4 faves***

Inside our brain, major nerves get inflammed and irritated, or blood vessels dialate to causes further inflammation. Our "feel good chemical" - seratonin - drops, and we hurt.

I rarely have headaches, so I'm crippled when it happens. Like you, I've experienced all kinds of headaches at one point or another.

Waking up this morning again with a minor headache finally has me frustrated enough to get serious about getting rid of it.

So what are 5 things I can do:

1) Eliminate coffee, chocolate, red wine, cheese, any foods with MSG or aspartame. Bummer.

2) Use over-the-counter medications like ibuprofen or aspirin.

3) Do aerobic exercise - biking, walking - anything to help me sweat because aerobics will relieve my stress and increase my pain killing endorphins. Yoga and medication can further reduce tension too.

4) Have great sex
5) Next time, don't wait four days to tend to a headache!

Energy

2010-11-02T11:10:00.002-07:00

The guys at The Future Well recently posted this video - The Human Energy Company - on their blog.

What a brilliant idea!!

What if your energy output - that is, the amount of energy you physically expend every day - related directly to your energy bill? What if you could pay your energy bill in time spent moving around, exercising, physically training?

We often neglect to think of food and drink as energy. Food is energy, and the amount we take in should equal the amount of energy we put out. Think of your body as a machine. It only requires a certain amount of gas....but we are putting way too much gas into our machines - we aren't burning enough. When your car needs gas, a gas light goes on. When your body needs fuel, it sends hunger signals. Too much stress, sedentary living, and poor mental health has us in situations where we can no longer easily decipher a true hunger signal. We are not sure when, what, nor how much food to eat.

So let's simplify - imagine if you could pay your bills in physical movement. The more you move each day, the less money you have to pay. This is a fantastic concept for health and happiness!

Not sure about you, but I'm going to start moving as much as I can.

Texting

2010-10-19T08:29:00.003-07:00

"Are you a tawlka or a texta?"

Sorry, allow me to remove the Jersey accent, "Are you a talker or a texter?"

I'm a talker. I like being verbal. It seems us talkers are slowly getting outnumbered by more and more texters every day. Texting is becoming the communication norm.

A recent article in the Wall Street Journal describes the rise of texting. Some of the numbers in this article shocked me. Teenagers receive over 3,000 texts per month?!?!? Wow.

Texting's rise over conversation is changing the way we interact, social scientists and researchers say. We default to text to relay difficult information. We stare at our phone when we want to avoid eye contact. Rather than make plans in advance, we engage in what Rich Ling, a researcher for the European telecom company Telenor and a professor at IT University in Copenhagen who studies teens and technology, has named "micro-coordination"—"I'll txt u in 10mins when I know wh/ restrnt."

Texting saves us time, but it steals from quiet reflection. "When people have a mobile device and have even the smallest increment of extra time, they will communicate with someone in their life," says Lee Rainie , director of the Pew Internet and American Life Project.....

As a 35 year old single woman, I understand the value in texting, but I also despise it. I dislike that men ask me out on dates and dear friends address difficult topics via text. It belittles the human element of relationships. I don't want a piece of technology to be the reason I can have special social and emotional experiences with friends and family. My Jersey accent gets lost through text!

So I find myself still thinking a lot about whether technology helps or hurts our health and happiness. Of course, the answer is both.

Technostress

2010-10-06T19:15:00.001-07:00

Last week I was reminded of how incredibly dependent I (and we) have become on technology. First, my IPhone crashed. I felt lost, discombobulated, and naked. After several of my own attempts to fix it, I contacted friends who are IPhone users to solicit their advice about how to remedy the situation. Each person offered good advice, but in the end, I had to go to the Genius Bar at Apple to bring my IPhone back to the life I wanted.

Two days later, my MacBook crashed. I have been having computer “issues” for the last few weeks, so I wasn’t too shocked, but it nevertheless put a huge glitch in my work schedule. The stress of not being socially, financially, and professionally connected to my world was tough to manage. Of course I reflected on what life was like before. It wasn’t that long ago that I was chatting with friends on a landline phone in my bedroom; and using computers only to write essays. Now, almost “too much” of my livelihood happens through my phone and computer. What made it better in the end was working with professionals from the Apple store who could help me effectively diagnose and fix my tech problems. That hand-holding played a key role in significantly diminishing my technostress.

But really, how much of my health and happiness requires technology? It’s an important question for each one of us to answer, mostly because the answer sheds light on how technology can help us and hurt us.

The question of what technology can do for our health and happiness is being asked by health innovators around the world. I’m heading to the Health 2.0 conference in San Francisco today to spend a few days listening to and interacting with leading health care and technology practitioners. To what extent can technology influence our health?

A recent article highlights the current status of mobile tech and health, stating:

...we must craft mobile components into solutions, which are meaningful and available to all of our patients. The true potential for mobile will be realized not by ever more complex iPhone apps, but rather by embedded data connections creating a new class of purpose-built, always connected devices, which reduce the complexity presented to the user.

Do you use your mobile technology to enhance your health?
Can technology change our habits? Increase access to health care? Make health care more affordable? Optimize the experiences of patients and doctors?

If the answers to these questions are yes (or even maybe) then we're heading in the right direction.

Anti-inflammatory

2010-09-22T14:36:00.001-07:00

I wear a bracelet on my left wrist. I've worn it for years, and it fits loose enough to slide up and down my wrist. Today, though, it's tight. So tight I can't move it around my wrist...so tight, it's leaving marks on my skin.

I woke up this morning feeling swollen and tired. My body is inflamed, literally.

Inflammation causes many undesirable experiences: pain, fatigue, irritability, disease. In my situation, several days of drinking too much caffeine and alcohol, doing too much intense exercise (I have an injury which is now aggravated from the exercise), and eating a poor diet, and neglecting high stress levels has made me this swollen. By the way, what "too much" and "high stress" means to each person is unique. I typically do not drink alcohol, limit myself to one coffee per day, eat a healthy diet, and practice varied exercise....which is why my behaviors this past week have affected me so.

So now what? What are simple tips for decreasing inflammation:

1) Lower intakes of alcohol, caffeine, salt, sugar, cola, white flour products, and junk food.

2) Eat as many raw fruits and veggies as you can (spinach, blueberries, pineapple, papaya, onion have high anti-inflammatory properties).

3) Use specific spices in your food (cayenne, cinnamon, ginger, tumeric have high anti-inflammatory properties). And if you don't cook, put cinnamon powder in your coffee or tea

Anti-inflammatory spices in my cabinet designated on a special shelf

4) Epsom Salts bath - soaking in epsom salts for 15 or more minutes decreases swelling.

How will I know when the inflammation is gone? When my bracelet slides up and down my wrist!

Insurance

2010-09-07T11:42:00.000-07:00

Health Insurance is a "hot button" topic. While the Obama administration is trying to figure out how to lower health care costs and tend to the millions of Americans without health insurance, the numbers are going up ...sadly.

Health insurance premiums went up 14% even though medical spending was flat this past year!
Whether you have health insurance or not, this affects you. It affects all of us.

I hear stories every day of friends and colleagues jumping through creative hoops just to qualify for decent health insurance. I'll use myself as an example: I practice top notch health behaviors (almost) every single day; I'm 35 years old and in perfect health; I don't smoke, I don't participate in any other high-risk behaviors, I don't have any special medical conditions....BUT I've had three reconstructive hip surgeries. Which means health insurance companies don't want to cover me. No matter how much I'm willing to pay. So I set up my small business LLC in such a way that guarantees I will qualify for coverage. My friend Ed - also one of the most habitually healthiest individuals I know - has diabetes, so thank goodness his new employer can provide him good insurance. It just shouldn't be this complicated!

It will be interesting to see how well the new federal mandate goes into action this month. Supposedly nobody will be denied quality health insurance anymore. The key word, of course, being quality. What, dear friends, are you getting from your health insurance company? Are you pleased with your coverage? Is your plan easy to understand/use/apply?

United Health Care unveiled a new program called Health in Numbers. It seems like a fairly robust program in which they tackle several barriers to health care such as:

-Access made easier with Technology = their Personalized Physician Search allows the best match between you and your providers; an IPhone app called DocGPS enables the user to locate the nearest participating provider;
-Customization made easier according to Disease Trends = their Diabetes Health Plan is personalized to anyone with diabetes;
-Navigating the System made easier with Social Support = their Health Advocates are always available to answer your most important questions; Electronic Medical Records (EMR) mean less paperwork for you and better management for them.

Does anyone use this program? If so, does it make your health care easier?

Tiramisu

2010-08-27T07:38:00.001-07:00

"Tiramisu is heaven in my mouth," said one of my friends recently during a dinner party. We were eating tiramisu (yum!) and I flashed back to when I was living in Italy... I enjoyed some fine tiramisu during those times, and it added extra padding to my bod, but more importantly, it signified happy times. I've never eaten tiramisu alone - only during celebratory dinners. I started thinking about the word "tiramisu" - the literal translation means "pull me up from" or "pick me up."

Health care providers and others doing innovative health care need to be like tiramisu. Positive, celebratory, encouraging, multi-layered...social. So much emphasis is place on sickness and not enough on wellness. Even when someone has just survived a major heart attack, there's opportunity for wellness. Opportunity for encouragement and celebration - the person is alive, right?! Capitalize on life, rather than focusing on death.

I've been fortunate to work with people who understand this. Especially in these past few months, more providers and agencies are looking to design positive strategies for more successful health care. Thank goodness! We are far from an effective health care delivery system, but if more folks focus on the positive, we'll get closer.

During a work project meeting yesterday, the topic of Alcoholics Anonymous came up. It came up because our group was discussing AA as an example of a "best practice" health care program. I've been thinking a lot about the success of AA, and then this morning, I went to one of my favorite blogs, The Future Well, to discover Jay Parkinson - a brilliant physician and social scientist - posted about AA. His analysis is spot on! And what he writes half way through his post reveals where the opportunity lies for folks in health care who "get it":

"Doctors are just so bad at lifestyle and behavior modification. Or maybe they’re just uninterested, or ill-prepared, or not reimbursed for social change? Maybe individual physicians think fixing these big hairy problems is too big of an issue for them to exert any effort? Medical care has pills and scalpels– not urban design, portion size, influential friends, walkability, and the complexities of the modern family structure. I should know. I got about 4 lectures in medical school on topics other than sickness." ~ Jay Parkinson, MD, MPH

Medical doctors are not to blame for our sickness. The way doctors serve these days, though, does not enhance our wellness because our system does not allow for enough time nor resources. Perhaps MDs are not supposed to be experts in health behavior change. Perhaps the resources need to come from outside the medical community.

There's so much opportunity for positive, quality work in health care. What's clear is that we need a "pick me up" strategy for effective health care and health promotion.

Crossfit

2010-08-12T09:23:00.001-07:00

A few years ago while I was visiting family in Los Angeles, a friend introduced me to Crossfit
He took me to Crossfit LA to observe a workout session. My first impression was that of a muscle gym - I figured anyone who did Crossfit must be dudes who wanted to get as big and strong as possible. The gym was "no frills' - a rubber floor, a few gymnastics rings, pull up bars, jump boxes, benches for lifting, jump ropes, resistance bands, kettle bells....no machines, just fitness toys. On the wall was a large white board with people's names listed according to time. Turns out those times revealed how long it took for each person to complete their workout. I was pleasantly surprised to see all kinds of people filter in for the session - men and women, younger and older, some in fantastic shape and others trying to get into shape.

Story short, Crossfit is a combination of P.E. class and boot camp. Crossfit instructors take time to teach each exercise in detail, then outline the workout for the day. An example workout is 400 meter warm up run followed by 15 sit-ups/15 pull-ups/15 squats/15 box jumps three times in a row. Everyone in the workout session must complete the workout as fast as they possibly can. The instructor starts the group off at the same time, and a large clock on the wall serves as the stopwatch. Motivational music blares through speakers, and while there is some competition, the spirit is collective support.

Even though I thought that workout in L.A. looked fun, I avoided Crossfit because of my injuries. After three hip surgeries, I worried that the intensity of Crossfit would harm me. Not to mention, I can't do a pull-up! The last time I did a pull-up, I was six years old playing on a jungle gym.

I recently changed my mind, though, and started doing Crossfit two weeks ago at Crossfit Hoboken. Here's why:

I need help with strength training.
As an endurance athlete, I have no troubles logging time cycling, hiking, swimming....but strength training is so boring. I just can't seem to do it on my own. Crossfit instructors teach the ins-and-outs of functional strength training, and the group atmosphere makes it fun.

I want to workout with a team.
Since I'm no longer competing in my sport, I don't have much chance to train with a team. I've been exercising alone these past few years and while I'm motivated enough to do it, it's lonely. Crossfit provides a community of people to hang out with - workout with, learn from, socialize with - and it's fun.

I can't seem to find that intensity elsewhere.
Intensity is so important to for fitness and overall health. I can't run anymore. I haven't run in over five years. Running is how I used to build intensity into my fitness routine. The Crossfit workout is intense! Everything about Crossfit (the instructors, my fellow workout buddies, the energy at the gym) promotes positive intensity, and it's fun.

I have special needs related to my previous injuries.
My exercise routine must cater to the physical limitations of my body. Crossfit instructors provide expertise that allows me to modify my workout so I don't get hurt. I'm back in L.A. this week, and yesterday I had the most fantastic experience with Zeb, an instructor at Paradiso Crossfit. Zeb (pictured below) taught me thrusters, front squats, wall ball, and kipping pull-ups. Again, it doesn't matter that I can't do a pull-up - because Zeb taught me how to incorporate the assistance I need using resistance bands...and it was FUN!

Crossfit provides not only a great workout, but ongoing education on fitness, nutrition, and overall lifestyle management for optimal health: see What is Fitness?

Crossfit isn't for everyone. I invited my friend, Kristen, to join me for this Crossfit adventure, and so far, we are having tons of fun! I'm still learning, so how long I continue to do Crossfit is yet to be seen. For now, though, I have wonderful, renewed energy for my fitness.

Anxiety

2010-08-03T10:02:00.009-07:00

Anxiety doesn’t feel very good. It’s normal, but knowing it’s normal might not necessarily make it feel better. When I asked one of my athlete-clients to describe her anxiety recently, she said, “My heart beats faster, I sweat, I get nervous, and my stomach hurts….and usually when I’m anxious, I can’t stop talking.” Sound familiar?

I work with a lot of athletes who struggle with anxiety. Anxiety can feel incredibly uncomfortable, and lead to bad decisions, disrupted sleep, poor recovery, overtraining, decreased performance, and/or illness and injury. Typically, an athlete contacts me when he or she realizes anxiety is impeding performance, training, and overall quality of life.

Researchers have been exploring how specific psychological variables – like anxiety - influence performance and other sport outcomes. The main argument is that individuals with high anxiety see situations as more stressful and consequently experience an elevated stress response, which may in turn predispose them to poor performance and injury. Decades of research reveal evidence for a strong relationship between anxiety and undesirable sport performance outcomes. Meaning, the higher your anxiety levels, the lower your performance and the greater your risk of illness or injury.

We all experience stress and anxiety, so why do some people prosper and some people fall? Think of it this way: stress is a state a person enters when certain demands require some sort of coping behaviors; arousal is a physiological signal that a state of stress has been entered (e.g., enlarged pupils, increased heart rate); and anxiety is the result of a person doubting his or her abilities to cope with the stressful situation. Thanks to evolution, we are armed with a fight-or-flight response that remains incredibly intact. So even though we’re no longer being chased by tigers, whenever our brain registers a stressor, we “turn on.” While we all “turn on” differently (i.e. uniquely experience stress, arousal, and anxiety), what we know is that within the sport arena, people who experience pre-competition “jitters” (anxiety) suffer a decrease in performance. Alternately, people who experience a pre-competition “pump up” (arousal) experience performance enhancement. This simple illustration depicts the stress-performance-injury relationship.

So what are some solutions to anxiety? Common management strategies include talk therapy, medication, meditation, and exercise. I coach my clients on using mental skills for effective anxiety management. Mental skills for optimal performance include cognitive reframing, positive self-talk, goal setting, focus strategies, and emotion management strategies, for instance. If you can use mental skills to view athletic situations as more challenging and less threatening, you can result with a useful stress response and therefore, increase your performance and decrease injury risk. Like all skills, these require learning and practice. And they work.

To read more about the concept of mental skills for sport performance, check out these resources:
Mental Skills for Sport
Books-
It's Not About the Bike by Lance Armstrong & Sally Jenkins
Born to Run by Christopher McDougall
Sport Psychology Library: Triathlon by Joe Baker and Whitney Sedgwick

Injury

2010-07-14T10:23:00.000-07:00

I got hurt yesterday. I was in a yoga class and something in my right knee popped. Loud. The pop was so loud that everyone in the yoga studio looked over at me. And I thought, "Oh shit." I calmly sat down on my mat, rubbed my knee, and within a few minutes, excused myself from class.

As I hobbled the nine blocks back to my apartment, I experienced every thought and emotion in the book. "What if's" and "Oh no's" and "Damn you's" and "Why did you's" and "Not again's." I felt frustrated, sad, anxious, angry, scared, and downright devastated. Devastated that I got hurt....again.

Professionally, I'm keenly aware of the psychosocial aspects of injury and re-injury. People who have high negative life stress, low social support, poor coping behaviors, previous injuries, and certain personality traits are more vulnerable to injury. Injured people experience anxiety, depression, low mood, lethargy, insomnia, loss of confidence and self-identity, etc. etc. etc. I know all of this.

To personally feel it is different. Being injured is exhausting. Being injured when you have very few resources and support is even more exhausting. The wisdom from years of hip surgeries and rehabilitation that I've managed to put into practice during these last 24 hours entails that I:

1) Breathe. Just breathe in order to slow down my mind/body. It's normal to be and feel reactive when you're injured. React as needed and channel the anxious energy out of your body. But as much as you can, just breathe.

2) Strategize. Find local resources that can help. Tap into health professionals, friends, and colleagues who can provide you with an army of healers so you can pursue a course of action that tends to your injury effectively.

3) Rest. Slow down. Sleep. A body that is injured needs time and space to recover.

4). Fuel. Take in elements that will heal your body. Water. Vitamins. Organic foods. Avoid foods and drinks that will exaccerbate your injury (alcohol, refined sugar, fried foods, etc.).

5) Ask. Ask for help. Inform people in your life what you need and hope that they will be available to serve in a supportive capacity.

6) Cry. Scream, cry, laugh...whatever you need to do to move the emotion out of your system so it does not become toxic.

I worked with a wonderful healer this morning. Gabe Luban of Rapid Relief in Santa Monica, CA. He provided the expertise I needed and educated me on what to do/not to do as I manage my injury. During my session with him, I asked questions. I cried. I laughed. And when I left, I felt better. And so the healing process begins.

Patience

2010-07-12T08:00:00.000-07:00

Knowing what you want - truly want - is an important element of health and happiness. It's not always that easy, though. Sometimes having this sort of ultimate clarity is a challenge. Each of us follows a unique path to this enlightenment, and certain people never really know what they want. Those who do, though, are one step closer to peaceful happiness.

Once you know what you want, figuring out how to pursue that happiness can present a whole different set of challenges. Pursuing true happiness involves intention, commitment, passion, courage, energy, discipline, support, compassion....and patience.

Patience. A virtue gone by the wayside. We've evolved into such an instant gratification society that the opportunity to practice patience is practically extinct. The benefits of being patient, however, are still as alive as ever. Patience keeps your heart healthy, your mind clear, your emotions calm, and your spirit steady. Without patience, we end up frustrated, scared, angry, anxiety, and sad.

So how can we integrate simple ways to practice patience into our daily lives?

1) Breathe. Breathe slowly and deeply. We all have to do it, it costs nothing, and it feels good.

2) Exercise. Physical activity triggers all sorts of beneficial biochemical reactions in your mind/body to keep energy paths clear and calm; and while your doing exercise, let your thoughts lead you to patience.

3) Talk. Talk to a friend, lover, family member....whomever is your confidant. Talking leads to clarity of thoughts, feelings, and desires.

4) Meditate. Meditation creates space between an activating event and a reaction. Learning meditation skills can enable us to call upon our patience when we need it the most.

Consider this:
"We begin with ourselves to understand our own true nature. We must recognize our habitual ways of thinking and the contents of our thoughts. Sometimes our thoughts run around in circles, and we are engulfed in distrust, pessimism, conflict, sorrow, or jealousy. When our mind is like that, our words and actions will naturally manifest these characteristics of mind and cause harm to ourselves and others. ...when a thought or idea arises, we recognize it and smile to it. That may be enough to make it cease. Appropriate mental attention brings us happiness, peace, clarity, and love. Inappropriate attention fills our mind with sorrow, anger, and prejudice. ....start by practicing mindfulness on our thoughts so we can see them clearly and prevent our mind from wandering down paths of unhealthy attention."
From "Teachings of Love" by Thich Nhat Hahn.

Kripalu

2010-06-30T15:02:00.001-07:00

Over the weekend, I spent two days at Kripalu in Massachusetts. Upon arrival, I was exhausted, upset, bloated, and sick with a cold. Two days of yoga, meditation, healing, self-attention, community, and stillness is exactly what the doctor ordered. Forget antibiotics, meditation is just as powerful.

More and more information is becoming available about the ability of the mind to heal, enhance, and change. Of course, Buddhists and other healers have been practicing on this premise forever. Neuroscience, neuroplasticity, radiology, physics, and other life and bio sciences are validating that the mind is what we need to train our physical and emotional selves.

Check out books like "Change your Brain, Change your Body" by Daniel G. Amen or "Train your Mind, Change your Brain" by Sharon Begley. These authors do a fantastic job of translating the science into every day terms we can use to better understand how the healing brain works. Mindfulness can be practiced in many forms: meditation, imagery, yoga, chanting, etc etc. All of us can experiment with mindfulness because all of us have to breathe - everyday, all the time. Just take a few minutes to focus solely on your breath. That's a form of mindfulness.

The word "yoga" means "union" in Sanskrit, the language of ancient India where yoga originated. The union occurs between the mind, body and spirit. Yoga is the practice of moving your body into physical poses and postures while focusing on your breathing. At Kripalu, I had the opportunity to do three yoga classes per day, plus an evening meditation. And at each session, I had a choice to do relaxation, moderate, vigorous, or dance yoga. Whether I was feeling tired, energized, playful, or scared, I could practice being mindful.

Yoga heals.

ROY G BIV

2010-06-17T07:34:00.002-07:00

The USDA is coming out with new dietary guidelines, but do the national guidelines translate to the way we eat?

In America, 35% of our total calories come from fats and added sugars (ribs, bacon, and butter...). The latest guidelines say to cut fats and added sugars down to 5-15% of our total intake so we can add more plant foods. Fantastic idea! Any ideas on how to put this plan into action?

You can watch and read the story here: http://abcnews.go.com/Health/w_DietAndFitnessNews/usda-nutrition-guidelines-focus-obese-unhealthy-population/story?id=10924134

Connie Diekman M.Ed, RD, LD, FADA - one of the most brilliant dieticians I know - offers her expertise in this story:

The idea is to provide incentives to offer healthier products, she said. Ideally, companies should take "key products and gradually but deliberately reduce [for example] the sodium contents of those foods."

"As the American palate gradually adjusts," she said, "those food products can remain front and center in the American diet but not contribute the excessive amounts of sugar, fats, and salt. Diekman said the key will be "helping consumers change their taste palate so that the shift in food choices is achievable."

I know Connie Diekman. I've worked with her, and as health practitioners go, she's gets it! Her advice to change our palate is spot on, but until the food industry provides better opportunities for that, what can we do now? How can we be better at consuming nutritious plant foods throughout the day?

One way is to ROY G BIV your plate.

Think about the colors of the rainbow (red, orange, yellow, green, blue, indigo, violet). Each time you eat, select fruits and veggies that represent every color of the rainbow. Or, if the rainbow image doesn't work for you, think about a box of crayons.

For example, this morning for breakfast, I had a protein smoothie made with strawberries and blueberries and a piece of whole grain toast spread with avocado (red, blue, and green). During my next feed, I'll be sure to aim for orange, yellow, indigo, or violet plants (e.g. zucchini, blackberries, eggplant, etc.). When you ROY G BIV your plate, you can be colorful and creative with your food. This is a simple strategy to make eating fun and nutritious.

Medicine

2010-06-15T08:13:00.000-07:00

Exercise is Medicine.

This is a fact. We may not think of it as such, but it is. Our bodies are made to move. And with appropriate "doses" of daily physical activity, we holistically function well. Since we've engineered the physical activity right out of lifestyles, it's now time to consider daily exercise as the medicine we need to prevent and reverse lifestyle diseases.

So much research is taking place in the worlds of neuroscience, physiology, psychology, behavioral medicine, etc. to clearly define exactly how exercise boosts our mood, energy, immunity, libido, cognition....and lowers our stress and disease risk. The evidence is undeniable. People who exercise regularly are happier, healthier, and more productive than those who don't. This is not new news.

The American Medical Association (AMA) and the American College of Sports Medicine (ACSM) have partnered to promote the global campaign "Exercise is Medicine" (http://exerciseismedicine.org/) which entails doctors prescribing exercise, much like they prescribe pills or other medications. We all know, though, that many patients struggle to adhere to doctors advice. If a patient can't take a pill on a regular basis, how can we expect that patient to exercise?

I heard Dr. Robert Sallis (founder of 'Exercise is Medicine' and ACSM past president) speak last year about this vision. He sees doctor's offices including fitness and behavioral health specialists in order to effectively implement this practice.

What do you think about physicians and exercise specialists partnering together? Could it work?

Talk

2010-06-12T07:29:00.000-07:00

"Hate is stronger than love." A commentator on ESPN radio said this yesterday. His words stopped me in my tracks. He continued to say things like "we live in a world where hate is stronger than love, where the negative has more power than the positive....people are more interested in drama than happiness...." I suddenly felt so sad.

Are we truly conditioned to be negative?

Think about how you were raised. What did you learn when you were growing up? I feel blessed to have learned from a clan who offered unconditional love, celebrations of hope, and words of encouragement. But members of my clan also regularly said things aloud like "Ugh, I'm so fat!" or "I'm ugly" or "I'm so stupid." They never said those things to me, but I spent my upbringing listening to them talk to themselves like that. And thus I - consciously or unconsciously - learned to talk to myself like that.

These are not words of love. My elders were so good at loving others but struggled to give that same love to themselves. Everyday we receive messages from our family, friends, the media....that influence our self-love.

What sort of self-love messages did you - do you - receive? The answer has a direct impact on your health and happiness. We must recognize our habitual ways of thinking and the contents of our thoughts because as long as we continue to reject ourselves, we continue to harm our own body, mind and spirit.

Self-talk is an important strategy for health behavior change. Meaning, the way you think and make statements, internally and/or externally, about yourself determines your habits. Self-talk serves as the seed for controlling perceptions, beliefs and attitudes.

Athletes use self-talk for performance enhancement. Whether it's to direct attention ("focus"), manage energy ("relax"), label the self or others ("I suck"), judge ("great job"), or contribute or undermine a performance, self-talk can be a very powerful skill. An athlete can use self-talk to boost confidence, focus attention, and/or correct bad habits. So can you.

Before you can use self-talk, though, you must be able to recognize it. Do you know how you talk to yourself? If not, a few ways to cultivate this awareness include:

-Journaling. Keep a daily, running memo of your thoughts. Let it be an organic flow of consciousness that includes the context (e.g. at work, during training, in the shower) in which the statements surfaced,

-Meditating. Dedicate time each day to being still to create time and space for your thoughts.

-Keeping score. Design a simple way to keep track of positive and negative thoughts. For example, a piggy bank. Every time you have a positive thought, place a penny in the bank. Remove a penny for every negative thought. What is your balance at the end of the week?

You may not be able to control the way others talk, but you have total control over self-talk. Or at least, you can. How are your words serving your health and happiness?

Stick

2010-06-09T07:48:00.001-07:00

Quick fixes don't work. Well, they may work, but they are just that: quick fixes. Examples of a quick fix include 10-day cleanse or a two week diet - "Lose 10 pounds in just 10 days!" We have become an instant gratification society, and in this Age of Distraction, we're always looking for the newest, fastest, easiest way to change. Thus allowing for multi-billion dollar diet and pharmaceutical industries.

For change to stick, you must become the change. It's not enough just to do the change, you have to be the change. The value of change is in the process.

Consider this- Buddhism teaches that a human being is made of five elements (called skandhas in Sanskrit): form (physical), feelings, perceptions, mental formations (thoughts), and consciousness. These five elements are dynamic, in a constant state of flux. The self is never static. Meaning, from the time you are born until the time you die, you can change yourself.

Regardless of religion, this platform provides a starting point for effective behavior change. Sound overwhelming? It's not. Theoretically, it's quite simple. You can't just tend to your body (ex. weight loss) and expect that your new, thinner self will stick; you must also shift your thoughts, feelings, attitudes, and identity about your new self. Take "The Biggest Loser" television show, for instance. Those contestants leave their homes to live at a ranch where they exercise 6-8 hours per day, eat minimal (yet nutritious) food, and have no distractions (no cell phones, internet, t.v., etc.) Their way of being is about maximal exercise, minimal caloric intake, and rest and recovery. That's it. We could all experience dramatic changes under those circumstance. Which is why most of those contestants gain back the weight after the show is over and they go home. They haven't properly tended to their self-talk, self-esteem, or self-identity.

Which brings up another issue related to changes that stick. Your environment. It's not just about your self, it's about your lifestyle. Where do you live? What are you doing during your days and nights? Is your environment set up to support the change you are trying to make?

Somebody I know celebrated 1,000 days of sobriety recently. The person next to him just celebrated 30 years of sobriety. They have become the change. Each day, these folks actively work on the process of change, recognizing that they and their worlds are in a constant state of flux.

A quick fix means spending time doing something you are not. If you want a change to stick, you must commit to the process of being - which means being open to addressing the elements of yourself and elements of your environment.

Access

2010-06-07T16:08:00.000-07:00

I recently learned that my OBGYN is no longer accepting my insurance. Meaning, unless I want to shell out hundreds of dollars per visit (plus any extra surrounding lab tests), I no longer have access to my doctor.

Droves of doctors are choosing to opt out of health insurance participation. USA Today published a front page story today about how doctors are implementing new fees-for-service to cover the costs that insurances companies wont: http://www.usatoday.com/news/health/2010-06-06-doctorsfees_N.htm
Unless you've been living under a rock, you've heard (and maybe you've even experienced) how broken our health care system is. The economics of medicine have become messy, at best. The inability to access health care is now commonplace.

Access to health care is a primary determinant of health and happiness. If you ask people why they don't have health insurance, they'll say they can't afford it or they can't get it. Health insurance companies can deny deny deny care (although hopefully the new federal legislation will curb this trend). Now, though, even if you have health insurance, you still may not be able to access the health professionals you need.

Accessing health care is only part of the picture, though. What about natural foods? Can you access a farmers market to buy healthy, nutritious foods? How about space to play? Can you access a park or a gym or a playground to engage in exercise and physical activities? Education? Can you or your children access good school? Access even extends to social relationships, meaning, can you access the people who bring joy and love into your life?

Access should be simple. It an ideal world, access to health care resources should be easy. In terms of establishing and maintaining healthy habits, access is crucial. You can have the strongest intentions and highest levels of motivation to eat nutritious foods, for instance, but that won't matter if those foods aren't anywhere to be found. This is a challenge for me every time I travel. Airlines serve incredibly unhealthy (if any) food, and airports are full of wall-to-wall fast food joints. Even if you can find, say, a pack of unsalted, raw almonds, a tiny bag costs a hundred dollars (ok, maybe not that much, but you get the point).

So what are some solutions to access-related challenges? Let's brainstorm....

When I work with clients, I go to their places. I go to their homes or offices so access is less of an issue. The internet (and other technologies) provides access to information. Designers and urban planners are doing more to create accessible spaces (wheelchair accessible buildings, parks, bike lanes, etc.). Local farmers markets are establishing more of a presence. Part of the challenge is making these (and other) solutions affordable. The really innovative minds are developing tools, methodologies, and programs that weave right into every day life. Effective lifestyle interventions, if you will.

So take some time to think about what you do and do not have access to every day and how that influences your health and happiness. And be sure to recognize how often you utilize what you have access to.

Synergy

2010-06-06T11:48:00.005-07:00

Over these past few months, I have experienced amazing synergy in the world of health care. Synergy is the interaction of two or more agents or forces so that their combined effect is greater than the sum of their individual effects. Health care innovation is inevitable. We are sick and frustrated and our social systems are inefficient. We've engineered the natural food, daily activity, and quality sleep right out of our lifestyles. We have the best health care providers in the world yet we can't easily access them. Our health care service delivery is broken. Obesity is a health care crisis. So is diabetes. Even if you don't feel the direct effects of these diseases, you pay for them. We all pay. And maybe you don't have diabetes, but what about insomia? Anxiety? Depression? Chronic pain?

The challenges are well documented. Americans - at home, at work, and at play - are facing collective mental, physical, emotional, financial, and spiritual struggles. Birthed from this is synergy. The organic synergy of brilliant, passionate people with creative, determined, and innovative minds who are applying their energies to our health care. People from medicine, public health, education, government, design, technology, law, and social policy who have shifted away from talking about the problems and walking towards the solutions. People with visions of a happy, healthy future. They may not have a lot of money. They may have even less tangible materials. But they are finding ways to innovate. Slowly but surely.

I, for one, feel blessed to be involved with this movement. I look forward to telling you stories about these people in the days that follow. For my part, I offer the science of health behavior change. I take a unique approach to health behavior change, and share my ideas and strategies in the form of health education, coaching, and consulting.

Changing a habit is hard. Habits form over time, so it takes time to change them. Time in the form of patience, process, persistence, and practice. Daily practice. And it's doable. Changing a habit is powerful. Changing a health habit is not only powerful, it's life-altering. Literally.

I intend to use this space to tell you about the work I do as well as the people I work with in hopes of creating more synergy.