Tag Archives: startup

Public Health in Action – Predictably Irrational

coursera-ariely-behavioral-econ

 

Richard H. Thaler is a kind of a big deal, and if you don’t know, now you know.

Professor Thaler, who teaches at the University of Chicago Booth School of Business, was awarded the Nobel Memorial Prize in Economic Sciences last month for his contributions to the field, specifically in understanding human behaviors. His life’s work illustrated that humans act irrationally in consistent ways that can be predicted and modeled. The implications of his work transcend all sectors. In 2008, Thaler co-authored “Nudge” and encouraged governments to use their insights for public good. Enrollment in retirement savings accounts significantly increased with a slight change: enrollment was the default option, which forced people to “opt out” if they weren’t interested. Observing and prioritizing human behavior, such as what behavioral economists describe above as “inertia”, over standard economic theories of rational actors, has made all the difference and has created myriad pathways into practical application.

Take the Center for Advanced Hindsight (CAH) at Duke, founded by Ted rockstar Dan Ariely. It houses decades worth of social and behavioral science knowledge, researchers AND entrepreneurs all under the same roof. CAH’s current focus has been working with startups that address financial security or health behaviors.

Public health, like economics, was built on the assumption that people behave rationally at all times. Thaler and Ariely have challenged those assumptions time and time again. We, as public health professionals, need to lean into uncertainty, especially when in matters of health behaviors. The populations that are most at-risk and need public health folks the most don’t live in ideal conditions. They may or may not have stable income, housing, transportation or have access to their next meal. If we can’t assume that people will behave rationally in a “normal” situation, we can’t assume they would behave rationally in a “distressed” situation.

Those are exactly the questions that crossed Allison Sosna’s mind at various points in her life and she shares her experience with us, below.

 

Allison Sosna, aka Chef Alli, is the founder of the MicroGreens Project

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as founder of MicroGreens.

Allison Sosna: I was in college and on the rowing team. Food, at that time, was synonymous for fuel that my body needed to perform. Sure, I ate healthily – lots of veggies, carbs, and protein (mostly chicken and eggs) but I did not give it any further thought. In my junior year, I lived in Italy. It was there that I was enlightened by the power of food on a community and would therein change the course of my life. I lived in a small neighborhood outside of Rome where residents all knew one another. They knew the barista and asked him how school was going. They wanted to know if the butcher’s cold had gone away. Everyone cared about one another and food was clearly the denominator of affection. In Rome, I realized that I wanted to do something with food and people. I did not come back wanting to be a chef, but, I saw that as a way for me to create food and community. So, I volunteered as a prep cook down the street when I got back to DC. I loved it. I loved the physical exertion that went into working on the line during dinner service. I loved wearing a uniform and feeling part of a community; a diverse community of women, men, people of different races, and different backgrounds with different stories. The sociologist in me was in love.

Shortly after, I went to culinary school, had a jaunt in fine dining, and then got a full time job at Dean and Deluca. While I learned a lot there, I realized I wanted to do more with my community; I didn’t want to feed rich people anymore. I had veered off course from the initial eureka moment. Leaving that job, I landed a job at a non-profit called DC Central Kitchen overseeing Fresh Start Catering, the social enterprise of the non-profit. When I started, we were providing the food services for a private school for at-risk boys, but it was generic and too similar to the lackluster school food that America is known for. Seeing such, I brought in healthier options, started making food like meatballs in-house, a salad bar, and marketed our vegetables to be more “fun” by using them as anecdotes. For example, I would say that foods like roasted carrots was a veggie that basketball players ate to perform better on the court (It’s true!). We had a lot of success there and that led us to win a food service bid for 8 DC Public Schools. We served thousands of meals a day to low-income kids who didn’t have easy access to fruits and vegetables (in 2010). Kids, of course, were coming to school with chips and soda, but I wanted to do something about it. I thought about the parents or guardians that were at home with the kids. How did they eat? Was it influencing their kids’ eating behaviors? How could I shift behavior? What I drew from all these questions was the question of their budget. How does a low-income family eat healthily? If I was a parent on SNAP, how did I use my money? Did I know how to cook? Did I know what to buy? The majority did not. As a result, I started MicroGreens and the Allison Sosna Group (ASG). ASG is my consulting “firm” for menu development, food service consulting, and private chef services. I had left my job to start MicroGreens, but also needed an income! I continue to consult today.

MicroGreens teaches kids to cook on a budget of $3.50 per meal, per family of four. The program has graduated over 150 kids across the country, with the help of community leaders that want to make their neighborhoods healthier. MicroGreens can be implemented anywhere, for any income level, for any length of time, and with any age group.

I moved to New York City in 2013 and while I was still working on MicroGreens and taking chef jobs, I needed an income and a job I truly cared about. So, I applied to jobs in public health nutrition with a focus on project coordination. After a year and a half of coming close to many jobs (NYC is tough!), I went back to school for a Master in Public Health degree.

Over the last year I’ve been intrigued with hospital food and its obligation (or lack thereof) to ensure that everyone has access to healthy food – from its staff to patients and also to visitors. While I am not trained in therapeutic meal development, I am trained to assist in cafeteria food services. I’ve been fortunate, by way of hustling and networking, to be part of the NYC Department of Health and Mental Hygiene’s Healthy Hospitals and Colleges Initiatives. We are working with food distributors to get chefs and food service directors healthier products for their hospital or college. It’s an incredibly rewarding experience to be on the other side helping the chef. I would have loved this help when I was working.

Me: What inspires you on a daily basis, especially when things get hard?

AS: On a daily basis, knowing that I am a part of something larger gets me through tough times. I know inherently that I am making a difference by bringing in healthier options for people. Every time a consumer replaces an unhealthy product for a healthier option, I know that I helped facilitate that. And as we all know too well, establishing healthy behaviors takes time.

As a student with a part-time job, I’m constantly moving around, not being able to cook for myself nearly as much as I want to, paying copious amounts for transportation, and don’t have a social life. But, I know I will, and am looking forward to graduating next year, when I can stay put and focus on doing work for my community full-time.

Moreover, the people I work with are incredibly supportive and that support allows me to focus on doing well in school and do an even better job at work.

Me: Tell us more about MicroGreens. How did you get into the social impact space? Why is it important to reach underprivileged populations?

AS: We must think about sustainability when we design programs. That being said, MicroGreens was originally going to be funded by a fast casual restaurant I was going to open. It would serve as part of the capital going into the non-profit. I’ve always believed that business needs to be part of the equation when designing interventions such as MicroGreens. I got 70% funded for the project but then had to let it go. I came close though and I’m proud of that.

If we do not focus on creating upstream programs first, we are doing a disservice to our communities, whether they are privileged or not. It truly does come down to the old adage “Give a person a fish and feed them for a day. Teach a person to fish and you feed them for a lifetime.”

One of the most impactful experiences I had with MicroGreens was not related to cooking. A student who had taken the class before was walking by our teaching classroom and walked in to say hi. He walked over to one of the kids who was having trouble cutting carrots (cutting carrots is hard!) and said “If you ever need help, let me know. I’m MicroGreens alumni.” Not only had this student learned skills and put them into action, but the program had instilled pride and confidence to teach others. There was a kindred relationship forming, a mentorship. That made me so proud.

Me: What are the current needs in New York City as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

AS: 1 in 9 residents have diabetes in NYC. Communities have little access to healthy foods blocks from affluent neighborhoods with endless healthy food choices. Soda ads saturate low-income areas and schools are without outside playgrounds. All determinants of health are so greatly intertwined that it can be overwhelming, especially for public health officials trying to make a difference. We talk a lot about that at school. How do we design interventions that encompass all contextual factors? First, by working with community stakeholders.

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Public Health’s ‘Moonshot’ – Part 2: A Local Context

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Courtesy of Inspector Insight

 

In the first post of this series, I briefly described healthcare system expenditures, as a percent of GDP, for the U.S. and a number of OECD member countries. When coupled with population health outcomes data, the amount spent per person on healthcare in the U.S. seems excessive and arguably wasteful. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Addressing the factors outside the healthcare system, through a reallocation of spending into social services such as employment programs and supportive housing, may play a key role in improving population health outcomes.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. As such, a contextual understanding of communities and their history is critical to tackling deep-seated social issues. Below, I focus on the community of Durham, North Carolina for place-based contextual understanding.

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The Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropic organization dedicated to improve health. RWJF’s focus, once solely on innovation in the healthcare system, has evolved to address the social and environmental factors as well in “building a culture of health.” Shifting the way society viewed health – from the absence of illness – was an integral part in this movement. It emphasized health as a resource for living fulfilling lives and collectively contributing to a competitive and thriving nation. It developed and strengthened relationships with key stakeholders and facilitated cross-sector collaboration. And it’s engaging leaders in communities.

In 2013, RWJF named six communities with its “Culture of Health Prize.” Distinct from its traditional grantmaking program, this prize awards $25,000 to communities for the work and successes they have already achieved. By shining a spotlight on a selected group of communities each year, RWJF is able to share lessons and first-hand knowledge with community leaders nationwide. Durham, North Carolina, was one of six communities selected for the Culture of Health Prize in 2014 for the work the Partnership for a Healthy Durham has done since 2004. The Partnership is just one example of community-engaged efforts to improve the lives of Durham residents. A few additional innovative models will be introduced in subsequent posts to illustrate social impact at the local level and offer ideas to accelerate their collective impact.

Durham

Approximately 250 miles southwest of our Nation’s capital, Durham is situated at the northernmost point of North Carolina’s Research Triangle, with Raleigh and Chapel Hill to its east and west, respectively. In its former life, the city was well-known for tobacco and textile production, but fast forward to 2017 and the “City of Medicine” is in a constant state of transformation. Durham was recently anointed as a destination for foodies, “The South’s Tastiest Town,” and boasts a vibrant and diverse culinary and social scene. A major factor in its Renaissance was a collective effort to attract entrepreneurs and catalyze innovation. Community and business leaders invested a significant amount of resources to revitalize downtown and its efforts appear to be paying off. Once described a “nascent startup scene” by Madrigal in the Atlantic, now exudes self-confidence with two Durham-based startups collecting back-to-back wins in 2014 and 2015 at Google Demo Day in Silicon Valley. The startup community has also made waves nationwide for its efforts to empower and nurture diversity; its epicenter, American Underground, a Google Tech Hub, houses 48.2% minority- or female-led companies thanks to initiatives like Code 2040 – a nonprofit organization that creates pathways to the technology industry for underrepresented minorities – and strong partnerships within the Research Triangle.

History

In the early 20th century, Durham had the most African American millionaires per capita than any other city in the U.S. Their success in finance and insurance was evident with a section of downtown named “Black Wall Street” (Forbes) and the city was also known as the “Capital of the Black Middle Class”. The Hayti District, an independent black community founded shortly after the Civil War, became a self-sufficient community and housed residents of all social class along with a variety of businesses, schools, library, hotel and a hospital. African Americans owned and operated over 200 businesses within the boundaries of the District. It flourished for decades through the 1940s until an urban renewal project in the 1950s tore through more than 200 acres in the heart of Hayti, displacing residents and businesses alike. The project was intended to ease commuting for suburban residents by realigning streets and construction of “the Durham Freeway”, NC-147.

Historically, urban regeneration or renewal served as a method for social reform in England to address substandard and unsanitary living conditions in rapidly growing industrialized cities. In the U.S., it came in the form of federal policies used to “reshape” American cities. The Housing Acts of 1949 and 1954 disbursed federal funding for cities to “acquire” areas identified as “slums” and were given to private developers to construct new housing. Additionally, the Federal Aid Highway Act of 1956 allocated 90% of federal funding to states to construct new highways that connected to the larger Interstate System. Large urban cities including New York, Chicago, Pittsburgh and Boston undertook urban renewal projects like Durham in the 1950s. While urban renewal projects generated economic development and improved quality of life in those cities, the destruction of neighborhoods left former residents in dire situations.

Poverty

A slow decline in manufacturing of textile and tobacco in Durham in the 1950s resulted in rising unemployment among working-class black residents due to segregation and discrimination. Coupled with urban renewal in the 1950s and 1960s and Civil Rights movements, the divide between whites and blacks grew. Sarah Willets of Indy Week describes an initial divide between affluent landowners and its workers even when the city was incorporated in 1869. An initial divide in opportunity which persists to this day.

“While some parts of Durham have single-digit and even less-than-1-percent poverty rates, in other neighborhoods, half the residents struggle to make ends meet.” — Sarah Willets, Indy Week

“We’ve always been taught the story of America is one of upward mobility. Durham very much embodies that. But some of the darker sides of the American story are here too.” — Justin Cook, Photographer, Slate Magazine

Photographer Justin Cook’s series, “Made in Durham” and various other pieces in the Indy illustrate what Willets captures in her story on Mayor Bell’s lasting dichotomous legacy – a thriving upward mobility amongst young professionals contrasted with historically African American neighborhoods that struggle with staggering rates of poverty and violence.

Alison Templeton, a research assistant at the UNC Center on Poverty, Work and Opportunity, released an update on urban poverty in Durham using current Census data in 2013. Templeton identified census tracts as “distressed” based on its performance compared to the state’s average on the following: per capita income, unemployment and poverty rates. 22% distressed census tracts in Durham County were identified in the report, which rose from 15% back in 2000. Other poverty-related statistics in Durham’s distressed tracts:

Poverty 46.7%
Child poverty 55.2%
Elderly poverty 25.6%
HS graduation 72.6%
Families led by Single Mothers 66.5%
Homeownership 27.6%

Poverty and the consequences of sustained poverty for individuals and communities significantly impact population health outcomes. Understanding historical context is a crucial first step in adequately addressing deep-seated social issues.

How Digital Health will Disrupt the US Healthcare System

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One-sixth of the US economy is spent on the US healthcare system.  About $2.8 trillion is spent annually or an average of $8,500 per person.  When compared to other countries, the size of the healthcare system alone would rank fifth in the world.  An informative article from Vox analyzes this spending through various comparisons and graphs.

US Healthcare: Past & Present

In the past decade, healthcare reform in the US has focused on providing people with more access to healthcare by means of affordable health insurance.  Key facets of the Affordable Care Act include non-discrimination of potential enrollees with chronic conditions and creating health insurance exchanges which helped consumers buy insurance.  Though strongly contested through King vs. Burwell and National Federation of Independent Business vs. Sebelius, the ACA remains as intact as law.

On the other end of the health spectrum is public health and preventive medicine.  The main principle of public health is prevention through health education, epidemiology and health behavior change, among others.  Several industries have grown in the space outside of direct healthcare, including health/wellness/fitness, complementary and alternative medicine and most recently wearable technology through apps and sensors, illustrated in a TED talk by Ted Wolf in “quantified self

Startups & The Future of Health

The market size of offerings outside of the healthcare space is growing and appears to be an ongoing trend.  Key stakeholders in healthcare are jockeying for position.  Hospitals systems like the Mayo Clinic and Cleveland Clinic, insurance companies like Blue Cross and Kaiser Permanente as well as retail giants CVS and Walgreens have all embraced recent trends.  The onus has been on consumer engagement to improve population-level health outcomes.  For example, Kaiser Permanente celebrated a 10-year anniversary of their social marketing campaign KP Thrive last year and continues to promote healthy lifestyles in partnerships with national initiatives. Even CVS rebranded to CVS Health to “help people on their path to better health.”

Two startups based in the Triangle of North Carolina have been growing rapidly and have the potential to impact population health.  First is startup, Validic, based in Durham, NC.  It offers wellness companies and healthcare providers a platform to manage and analyze their patients’ wearable technology-based data.  In its most recent round of funding, Validic secured another $12.5 million, which included Kaiser Permanente’s ventures arm, Kaiser Ventures.  Considering the number of apps to collect health data from various sources, Validic looks to be a key player in data aggregation and management of personal health data.

The second startup that grabbed the attention of “high-profile investors” a few weeks ago is Predictify.me. The Raleigh-based startup takes large data sets and “extrapolates” them into the future data sets.  Future data sets enable analysts to forecast and can plan strategic moves accordingly.  Chief Data Scientist, Dr. Usmani, is renowned for his work in public safety and counter-terrorism in his native country of Pakistan.  Despite starting in the private sector for consumer buying habits, Dr. Usmani and Predictify.me aims to focus on making social impact.  Innovating to improve the healthcare system just may be the social impact that Predictify.me is looking for.  Imagine if predictive analysis took place with an individual health consumer.  How might researchers, public health practitioners and companies utilize this to keep individuals healthy?

The US economy cannot sustain the pace of healthcare spending and the potential applications outside of the healthcare system seem ready to bring more value for each dollar spent.  How wearable technology will affect population-level health outcomes is still unknown.  But with Validic, Predictify.me and others leveraging technology to obtain, manage and analyze data sets, don’t be surprised if health outcomes start to improve.

Originally published on Startup Grind

Public Health in Action – Health Doesn’t Have to Cost an Arm and a Leg

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Braden Rawls
CEO, Vital Plan

I met Braden at a startup event coordinated by the Triangle Startup Weekend crew.  I was there as a volunteer, but I met some interesting people and they insisted that I talk with Braden.  The “theme” or scope of that weekend was to drive more women into entrepreneurship since other events consisted of a majority male audience.  From what I heard, the turnout was 70/30 in favor of women and they had some great ideas.  Braden embodies the mentality and determination it takes to succeed and I hope she inspires more women to jump into the entrepreneurship world.

Now let’s get to the interview!

Me: Tell us about Vital Plan and how you got involved.  Start from high school or college and describe your evolution into your current role.

Braden: My major at UNC-Chapel Hill was Public Relations in the Journalism school; I really enjoyed the classes, but wasn’t sure where I wanted to take the degree. Most PR graduates work for an advertising firm after college, but I didn’t feel called to go that route. Towards the end of my sophomore year, I heard about a new “entrepreneurship” minor in the works. I thought that sounded like a good complement to my major and a chance to learn something new.

One class in and I was hooked. We went through case studies of great entrepreneurs over the past century and it was fascinating to me how they were able to turn “problems” into opportunities. I felt a connection immediately to the students and professors in this entrepreneurship community who were also energized by “problem solving.” I decided that I wanted to be an entrepreneur; I just needed an idea! This was before the startup boom in Raleigh/Durham, so there were not a lot of resources for someone who wanted to start a company or work for a startup.

After I graduated, I took a job in Raleigh with a successful entrepreneur as his “right hand” assistant. I learned a ton, but really wanted to pursue my own startup company. Knowing this, my dad presented me with the idea of helping him to turn his passions and expertise around herbal therapy into a scalable business model.  I started working on this nights and weekends, and it quickly became a passion. It took several years of nights and weekends to develop a profitable business where I could go full time and hire staff, but it was worth it. I love what I do, and Vital Plan is well positioned for growth. It’s an exciting time!

Me: What inspires you on a daily basis, especially when things get hard?

Braden: My team at Vital Plan. Everyone has put so much hard work into building this company and it saddens me when I realize there is a possibility that it could all cave in. My father is so passionate and sincere about helping people to improve their health and I think it would be a shame if we cannot succeed in connecting him with the right audience to hear this message. Also our angel investors took a leap to invest in a “non-tech” company and have extended much more of their time than the average investor. I am motivated to make this a success for them in appreciation for their tremendous support and encouragement.

Also, the realization that I need to pay my bills and won’t have a graduate degree or savings to fall back on if Vital Plan doesn’t grow. Ha! That is of course a huge motivating factor once you choose the startup route over grad school or a corporate job.

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

Braden: I think the realization that 95% of health symptoms are being fueled by our own actions is the key. When it sets in for people that their diet or stressful lifestyle makes them feel sick and uncomfortable, they are much likely to step up and take accountability for their actions. It is easy to avoid accountability when you have a mindset that your digestive issues, pain, and fatigue fell out of the sky and made you a victim. When you finally accept that those symptoms are a direct result of your daily actions, such as overindulging in sugar, drinking, or adrenaline, there is no one else to blame and it becomes easier to halt destructive behaviors.

Me: What are some things/concepts/ideas you’ve seen either here in the U.S. or abroad that, if disseminated in an effective way, would change how people think about their own health?

Braden: Stress is a big contributing factor to illness. The good news is, the most effective stress management techniques are free! Learning simple breathing exercises and short meditations to incorporate into your day can make a huge difference. Meditations can be effective before stress hits, because they prepare you to handle difficult situations when they come your way.

And of course I have to plug herbal therapy. America left herbal therapy in the dust years ago for the promise that pharmaceutical treatments offered. While drug therapy can be very powerful in acute situations, there is a lot of power in herbal medicine for managing stress and encouraging wellness. I am so happy to see a movement building in America to embrace natural therapies.

Me: What are the current needs in your city as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

Braden: The 9 to 5 sedentary workday is a huge health threat that is flying under the radar. Sitting at a computer screen all day is terrible for your digestion, cardiovascular health, blood flow, etc. and a contributing factor to obesity. Not to mention that these environments encourage consumption of sugar and processed foods. I think that companies who encourage their employees to take short breaks throughout the day and give them space to accommodate this will go a long way. Offering healthful snacks and limiting sugary temptations like doughnuts and cupcakes is also a huge step in the right direction.