Behavior change is hard. That's well established in public health research. Despite millions of dollars and thousands of studies trying to get people to change their habits and improve their health, and despite plenty of evidence that shows that when people in fact *do* change their behavior their health improves, well, most people keep acting pretty much the same way. I've written about this before, but it's one of the big cunundrum's behind personalized medicine or, more specifically, personal genomics. It's one thing to know that we have an elevated risk, and it's a second thing to know that by changing our diet or exercise habits we can ameliorate that risk. But it's quite a different thing to actually go out and do that. And this fact puts tremendous strain on our healthcare system, and means that, despite the promise of predictive medicine, we will always be dealing with late-stage conditions that could've been avoided.
Here I'll quote from an email sent by a secret physician source:
My opinion about why medical care focuses so much on treatment of advanced disease is that people really do not want to participate in preventive health care. Take screening for colon cancer. It's been around for decades and there is hard data to show that the mortality for colon cancer has decreased significantly in those who are screened. (Of course, 'those who are screened' are primarily upper middle class white folk, but that's an entirely different topic) I am currently seeing 50-60 patients a week, 70% of whom come into my office for rectal bleeding, a sign of colon cancer. I ask everyone of them if they have had a colonoscopy yet. Of those who are in a high-risk category - family history or age over 50 - at least half have not. (Approx. 50-60% of the 50-60 pts are high risk) When I ask if they know of the association between bleeding and colon cancer and whether they knew colonoscopy could prevent colon cancer, they will say 'Yeah my doctor told me to get one, but I don't want to go through that test'. It is this (relatively) small percentage of people who end up neglecting medical advice and seek treatment only for advanced disease who end up costing our health care system so much money.
Liver transplants are another example. I'm not sure of the exact figures on this but I'm pretty sure the majority of liver transplants are in people who are alcoholics, albeit reformed. And the cost of a single liver transplant would probably pay for intensive alcohol rehab for dozens of people.
In essence, patient's actions are a much larger driving force in terms of health care costs than society wants to admit.
It's especially frustrating, because so much of what we mean by "behavior change" boils down to two things: Eat better. Get more exercise. (there's a third: Quit smoking. But that has all sorts of separate implications, which I hope to deal with later.)
All this is prelude to mentioning one novel approach to behavior change: Virgin HealthMiles.
Part of the Richard Branson Virgin empire, Virgin HealthMiles is a web-based tool to help people exercise more and more regularly. It is a fancied up exercise diary: you join, enter some exercise goals, and track your progress. There are a growing number of tools like this out there (Nike+ is a cool one for runners, that allows open sharing of routes and stats). But Virgin HealthMiles is different because it adopts the "miles" concept from frequent flier programs as a reward system. The more exercise you do, and the closer you track to your goals, the more miles you get; miles can be redeemed for hot fudge sunda... oops, redeemed for HealthCash, which can be converted into gift certificates at various stores.
Right now, HealthMiles is open only through employer health benefits programs; it's not open to individuals.
And the million dollar question: Does it work? Well, there's no evidence on the site, besides some anecdotal information. But my guess is it is likely more effective for people than just trying to remember that they should be exercising. The traditional way of advocating behavior change - the way the NIH does it - advocates similar principals (goals, targets, etc) Especially for the data-inclined, the life-hacker crowd, this sort of stuff is like catnip - you keep coming back to check you stats. And the thing is, as Kevin Kelly has noted, more and more of us are finding utility in tracking our lives. This isn't a fringe thing, it's an early adopter thing, and the masses are catching on (see the popularity of Nike+ and all the spin off mapping sites).