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Tracey Koehlmoss on being policy makers in our own lives

25 Jul, 11 | by BMJ Group

Tracey Koehlmoos

I am writing to you not from Bangladesh but rather from the Institute of Medicine’s workshop on country-level decision making for control of chronic diseases being held from 19-21 July at the House of Sweden in Washington, DC. On Wednesday I presented on “data availability and gaps in Bangladesh,” which I worked very hard to make as riveting as possible despite the snooze-inducing title.  The session was based on portions of a non-communicable disease case study I am completing for the Institute of Medicine (IOM).

In another blog I will write more about the key messages from this synergistic IOM meeting hosted by Bridget Kelly and Rachel Nugent. Bridget and Rachel brought together a glittering array of policy makers, agenda setters, public and private sector leaders, scientists, economists, and more than a handful of enthusiastic young professionals as the world races through the final weeks of preparation for the United Nations General Assembly High Level meeting on Non-communicable Disease Control and Prevention, which, in case you have been sleeping or otherwise not paying attention, will be held in New York on 19-20 September 2011.

On Thursday I had the pleasure of sitting next to the charming Franklin Apfel, the managing director and founder of the World Health Communication Associates. Franklin charged the meeting participants with the idea that when it comes to NCDs:

“We are all policy makers in our own home. In our own lives, every day.”

The message is that with NCDs, the way forward is not just about what can be done by policy makers, program planners, mass media campaigns, and the health system, but very much depends on individual choices. To that end, Franklin and the WHCA have been working on a series of balance score cards that can help individuals, communities, and policy makers have an easier time of making healthy choices. It is an empowering tool that can improve health literacy.

There is something appealing about being a “policy maker” in my own home, which sounds rather lofty albeit more dictatorial than “mother.” I thought I would test Franklin’s concept by applying the tool to my life and family and sharing the tool and results.

So here are the balanced score card questions and results:

1. Tobacco control policies: The Koehlmoos household has a complete tobacco ban. It is stricter than Bhutan at my house. Family members do not smoke, chew, or dip, and the no public or private smoking law extends through the yard and applies equally to family, friends, employees, and contractors.

2. Alcohol: Not even a beer in the refrigerator. There are a few bottles of wine and decent Scotch in a cabinet in the event of guests and to pass along as hostess gifts. I do not drink alcohol in part because I do not need the empty calories.

3. Salt: This question contains elements of public information campaigns and working with industry. In my house, I am the food production industry. Since I started working on NCDs, I put half the salt into recipes or omit it completely—especially if an ingredient comes out of a can or box. Also, I stopped putting the salt shaker on the table with meals, which sometimes annoys other policy makers within my household causing us to engage in détente over chicken and rice.

4. Trans-fats: This is an easy “no” but in the tool it has to do with replacing trans-fats with poly-unsaturated fats. I am not even sure how I would make or use trans-fats. In terms of public awareness campaigns, I have also taught the boys that just because a product says that it is “trans-fat free” does not mean it is healthy or fat-free.

5. Exercise and diet: This includes active campaigns and public transport policies. In addition to attempting to work out six days a week, we talk about daily work outs and sporting activities with the boys over dinner each evening. It is rather a tradeoff between walking everywhere and living somewhere with unreliable sidewalks, dangerous traffic, and a lot of automobile exhaust. Now that I travel so much of the time, I will admit to having become a little rounder than I like to be as I tend not to work out when I am in the air or living out of a suitcase—despite always having my running shoes in the suitcase. I should definitely make a greater effort.

6. Generic drugs for primary care: I am not sure what this one means in the context of the house and should have asked Franklin how to apply this question when I had the chance. Multivitamins are available in the house and I take one in the morning along with a couple of chewy calcium and vitamin D supplements. The calcium chews are expensive. My wallet would be healthier if I did not buy them, but once at a zinc scale up meeting a famous health researcher and physician whom I admire walked up to me and emphatically announced, “Tracey, I think you need to start taking vitamin D supplements. Everyday.”

I suspect that in the weeks ahead, we will apply the national level tool in Bangladesh and those results will perhaps constitute a scholarly paper; for now, applied at home, it is material suitable only for this blog. Perhaps you will join me in by thinking like a “policy maker in your own home” and applying the balanced score card to your life and sharing your results in the response.  I am curious as to whether I am the only person who does not have a glass of wine with dinner, does not let friends smoke in the yard, or does not put salt on the dinner table.  Again, to read more about the score card visit the WHCA website.

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  • Andrew M.

    Great article Tracey, I think these are just the type of tools that will be the most helpful for addressing systemic lifestyle issues related to chronic diseases. Namely, providing easy-to-implement tools that can give immediate information feedback. There might also be some nice outcomes with these scorecards that we can track over time. Keep up the good policy-making.

  • David James Koehlmoos

    Thanks for telling me about your most recent blog post, mom.
    We don't usually have salt on the table and the are no form of drugs in any part of the house. And I do remember the day Nona died from lung cancer, no matter how hard she tried quitting smoking she was too addicted.
    RIP

  • Richard Smith

    A great blog, Tracey. Health policy Chez Smith is not so good. But I think you fall down on taking all those pills. They won't do you any good. throw them away.

  • Soozrn

    As someone who has had a variety of noncommunicable diseases (cancer, diabetes, hyperlipidemia and depression) before age 35, I have to agree with the idea that a person’s health is their responsibility. I regret the years smoking, drinking to excess, the junk food (though I still crave chips and diet coke) and the vague notion that I would “get healthy someday” by magical thinking. Realistically, I have dodged many a bullet, and realistically, at least half of my years have passed. Should I be blessed enough to have long life, I don’t want to be incapacitated. So, I also recently became my own policy maker, avoiding alcohol, the salt shaker on the table, the smoking, the drivethru fast food, the pastry shops. I have started to excercise more often, more intensely and more consistently. Thanks, Tracey, for keeping your kids from becoming statistics and inspring the rest of us.

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