Institute 2010: Closing Keynote – Behavior Change Lessons from Dr. Jeffrey Koplan

by Scout

Change is always happening

The Institute still has a half day of classes, but we’re having our closing keynote now by Dr. Jeffrey Koplan, former director of CDC.

Dr. Koplan takes us into a time machine first, has us remember 30 yrs ago to help us see how much behavior change really is possible. He talks about the hospitals with clouds of smoke in them, the drivers who never wore seat belts, how many of us are trying to exercise at least a few times a week, drinking lower fat milk, and how fewer of us are having unprotected sex with stranger. (Well, ok, no one in the room raised their hands when he asked if any of us had unprotected sex with a stranger last night, but that could be an example of social acceptability response bias. Ahh the vagaries of data collection.)

Tobacco as an infectious disease

While tobacco isn’t an infectious organism, Dr. Koplan brings up how the model of tobacco use is actually really similar to the model of infectious disease transmission. This resonates with me a lot, I’ve watched my friends in Providence smoke more simply because a popular person in their circle smokes more in front of them. I really feel tobacco is a Socially Transmitted Disease (STD), and looking at it as such helps us understand when and how folk smoke. In Dr. Koplan’s analysis, the relatively steady rate of 19% smoking in US is just waiting for tobacco control folk to blink, then it’ll move right back up.

Soberingly, there are a billion male smokers in the world and 250M female smokers. Some countries are where the U.S. was in the 1950s, with high prevalence rates, high tobacco production rates, and little to no tobacco control activity. Dr. Koplan posits that hopefully the faster transmission of behaviors and behavior changes across the world now might help these countries speed through the social arc from the 50s to the 2010s in less than the 60 years it took the U.S.

Eating, eating, eating, and not moving

Majority of states have over 25% of their adults with their BMI over 30 (i.e. obese) and in 9 states 30% of the adults have BMI over 30. Obesity truly is an epidemic in the U.S. And no, it has nothing to do with genes, it has to do with our behavior. The impact of this will be with us for generations. Interestingly, obesity spreads like an epidemic too, if you look at the BMI of people in Mexico, it goes up the closer you get to the U.S. border. He notes that so much of this lack of physical activity is related to our environment, as evidenced by how people in large cities with public transportation systems are more physically fit than people who live in suburban style sprawl cities or communities. If it’s hard for people to fit exercise into their routine day, they don’t exercise as much. (I hear those New Yorkers giving little snorts as I write.)

No marathon runners or whippets

The impact on our health of the triple threat of tobacco, diet and exercise cannot be overestimated. But Dr. Koplan urges us to be realistic, we’re taking on the largest health issues of our day, but we don’t need to make giant changes, sometimes small feasible changes can really make a big difference. Reminds me of one of the studies brought up in the opening plenary, from the book Switched, where a series of ads showing one glass of whole milk equaled the fat in five slices of bacon increased the skim milk use from 14-40% in just a few months.

Believe in desserts

Of course it’s slightly odd that his whole talk was given while we were munching, munching, munching on our lunches. Dr. Koplan urges us to not only believe in the strength of the impacts we’ll make, but to stay focused on motivating ourselves to keep up the good work, in this case…or in other words, believing in dessert!

P.S. Believe in collaborations

While last Fall CDC brought together the tobacco and wellness folk working on Communities Putting Prevention to Work (CPPW) awards, this is the first time the state tobacco and state diabetes folk have had a conference together. After Dr. Koplan closes the head of diabetes at CDC gets a huge round of applause from everyone in appreciation for having this institute be a new collaboration between related areas of health. And she urges us all to continue to cross-pollinate these issues by presenting at allied conferences for each issue.