Breaking the Cycle of Chronic Disease
BY GRACE MOEN
Many of the most costly chronic diseases, both economically and in quality of life, can be alleviated by changes to lifestyle that are notoriously difficult to implement, especially at scale. As such, swapping old habits for new ones - or what we call Behavior Change - is arguably the single most promising sector of healthcare today.
The more we learn about what behaviors and foods are healthiest for our bodies, the more we learn about how connected they are to the states of chronic disease management and prevention. “We were prescribing drugs and procedures but we weren’t prescribing nutrition, mental health, fitness, sleep, supplements, things that can actually really help people heal their bodies and reverse a lot of the chronic diseases that are most common today,” remarks Dr. Robin Berzin.
When it comes to lifestyle, old habits are hard to break. Humans are as varied as their motivators, but over the years, experts have unearthed some clues: consumer spending can show us exactly how much bang for the healthcare buck will actually move the needle in behavior changes, while technology and digital solutions play an increasingly important role as a supportive mechanism for people making those changes. The neurological reward system can be amplified by gamification apps, while the quantified self movement can itself be a reward.
Behavior Change is classic operant conditioning, but with one caveat: when we’re solving for chronic disease, the rewards of good behavior may not be seen for years or even decades. Thus, instant gratification plays no role here. Therefore the reward must be embedded in the behavior change itself. Especially so because often the reward is not a thing but rather the absence of it, the absence of disease.
Some people are encouraged by simply watching the numbers tick up and down on their smartwatch. Whether it be weight lost, calories consumed, or steps walked, they’re data motivated people. The quantified self movement has long since reached ubiquity resulting in an entire ecosystem of connected devices built upon it. The data transparency it offers is motivational, therefore also a form of gamification.
Gamification leverages competitive or cooperative tactics to encourage behavior change in the form of a game. Remember that, with chronic disease management, the reward must be the behavior itself, which is why gamification is so popular: it’s fun. And thus highly likely to be repeated.
Affordability also plays a critical role in making sustainable personal changes. Research shows us that when pocket strings tighten, healthcare rationing sets in. Nobody should ever have to decide between a copay and groceries. And yet they do, every day. “Self-rationing health care to cost is a serious challenge for people managing chronic conditions, for whom postponing or opting out of care due to cost can lead to longer-term medical complications and even higher healthcare costs,” remarks Jane Sarasohn-Kahn in her book HealthConsuming. It’s not just anecdotal: “45 million Americans did not fill a prescription in 2016 due to the cost of medications.”
Even small changes in behavior can go a long way in impacting the state of chronic disease. Change does not happen in a vacuum, but when the appropriate structural systems are in place, paired with personalized motivators, patients receive the support and encouragement they need to manage their chronic disease or even prevent it before it even starts.
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