It is known that improving health outcomes for patients involves more than physician visits. Successful improvement in health and lifestyle requires widespread societal change. The most successful of these changes occurs when a systemic culture shift occurs. Much like the tobacco movement, there is often a systemic financial gain that comes at the expense of population health. Over the past 2 decades there has been a successful culture shift that has decreased the rates of smoking across the board. This required a massive undertaking on the part of policy makers, health care systems, outreach groups, and more. The most imminent problem plaguing society today that requires a culture shift is the onslaught of diabetogenic, carcinogenic, and overall unhealthy food choices.
Diabetes, heart disease, obesity and cancer have become major killers worldwide. Creating insulin secretagogues, antihypertensive medications, or widespread statin and aspirin use will not fix this problem. A shift in our relationship with food and nutrition will be fundamentally required to halt the burden of these diseases. Homo Sapien’s success as a species is partially explained by its ability to thrive on a variety of foods. Since the industrial revolution, this ability has been hijacked by widespread availability of sugar, simple carbohydrates, and processed foods. Our brains are wired to feel good with the consumption of these foods and it is no coincidence that these items have become the backbone of our worldwide diet.
There are countless systemic changes that could be made within our system to address this issue, however the one I have witnessed throughout all domains of my life is the use of these foods as constant rewards for even the simplest of accomplishment. The contradictory nature of this is most evident in health care. During my journey to become a physician, I’ve worked in a pharmacy, diabetes laboratory, and countless hospitals and clinics. In all of these locations, sugar has been used as a reward for even the most basic accomplishments. It’s someone’s birthday? Cookies in the breakroom. Met a QI goal? Candies up front. Staff appreciation? Cupcakes for everyone. Providing this sugar stimulus at workplaces where a sugar addicted society spends most of its awake hours is akin to providing constant reward vodka shots to alcoholics seeing recovery. This is not a fault of the individuals who make up the system but rather the system itself. Do these rewards even provide a sustainable benefit on employee satisfaction? Even if they do, are they creating more problems than the positive reinforcement behavior change they are used for? How do we change this?
For long lasting culture change as stepwise approach is necessary. First, I must personally avoid using this kind of stimulus in my own life. Instead of using sugar and food treats, I take time to pursue meaningful activities that I get enjoyment from. Next I should extend this belief to those closest to me. Having discussions with these people that challenge the status quo and get them thinking is important. Why do we NEED cake on birthdays? Would we feel less important if the cake was missing? Would we feel less loved? In the professional environment it will be important to gather data on staff satisfaction rates in response to sugar treats using observational study. Using information from this data and reviewing which types of reward actually lead to long term fulfillment, we can study the impact of these interventions at our own workplace. The last step would be using our workplace as a model for others across the system. Hopefully staff would see the improvement in their own lives and take this mindset change with them wherever they go.
Creating sustainable culture change regarding sugar as a reward in our society will not be easy. It is our responsibility as healthcare professionals to be at the forefront of this revolution. To do this we must understand that our brains have become hijacked by these foods in the same way tobacco, alcohol, cocaine and heroin. We must realize that these foods have become weaponized to produce profits, not health societies. Successful transition away from these rewards in our own lives and workplaces is the first step to systemic culture change.