Tuesday, March 15, 2011

Justifying Simplicity in the Face of Complexity

Anyone contemplating the problem of chronic disease plaguing countries in the second or third stages of the epidemiologic transition has to be awed by its overwhelming complexity. Of course, many of these diseases are heavily influenced by modern dietary patterns interwoven with many biological and social factors (Popkin 2001; Glass and McAtee, 2006). Here in Canada the problem is no less significant, and Health Canada is working hard on this problem. One area that I will focus on is the food guide, which was developed as one small tool in this battle.

When looking at the latest iteration of Health Canada’s food guide the first graphical element I see is a dizzying array of information simultaneously competing for attention. Further compounding the problem is a cacophony of nutritional messages that come in every shape and form of media, from TV to magazines to Twitter. The overall picture can totally bewilder anyone trying to make healthy lifestyle changes. It is no surprise that public health’s efforts to change behavior are equally as complex as the problems they are trying to change, but does the messaging have to be complex, too?

One important theory from social psychology says no. The limited resource view, developed by Roy Baumeister, states that the brain has only so much glucose to devote to given tasks, and when glucose levels become depleted people will give up more challenging problems (Baumeister et al, 2003;Baumeister and Vohs, 2007). One such challenging problem is changing one’s behavior. People of low socioeconomic status (SES) tend to be taxed by social exclusion, prejudice, and higher levels of work stress (Marmot, 2005). Thus, when faced with challenges like losing weight, exercising, or changing dietary habits, many people simply throw in the towel and quit (Baumeister et al, 2003). I think Health Canada’s food guide can take some advice from this theory and simplify its message.

Here are my three recommendations to Health Canada’s Food Guide Advisory Committee. One is to make a commitment to simpler, more meaningful messages that an average person can understand and follow. Forget about the recommended daily allowances of dairy, grains, proteins, and oils and fats plus leave off the last page with 8 other recommendations. It’s too much information. Focus on the part with the biggest bang for the buck: fruits and vegetables.

If there is one thing you can suggest about increasing health through dietary change it is increasing consumption of fruit and vegetables. Increased fruit and vegetable consumption is associated with eating less processed foods and reducing mortality from coronary heart disease (CHD) and many types of cancer (Crowe et al, 2011:Dauchet et al., 2006). Those two diseases claim the most lives of Canadians (WHO, 2005).

My second recommendation to Health Canada would be that instead of spending so much money and effort on a printed food guide that is widely distributed, I would use the budget differently. I would scale down the food guide and make it web-only, targeted to health educators, institutions who specifically need it, and motivated individuals. Then I would hire a marketing/PR firm to develop a really simple, punchy logo/image and ad campaign to focus on the essential message, one that becomes engrained in the public psyche.

Finally, my third approach would be to work like gangbusters to convince partners in the battle against chronic disease, such as the Heart and Stroke Foundation, BC Cancer Agency and others, to support Health Canada’s message for increasing fruit and vegetable consumption.

Creating a movement of social change needs a consistent, simple message. The average person is being bombarded by all kinds of information; they are stressed and they don’t have the cognitive resources to make the kinds of changes that the current food guide recommends. They just need a simple message to follow.


Baumeister, R., Vohs, K.D. (2007). Self-regulation, ego depletion, and motivation. Social and Personality Psychology Compass , 1(1):115-128 DOI:10.111/j.1751-90042007.0001.x

Crowe FL, Roddam AW, Key TJ, et al European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart Study Collaborators. (2011). Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Eur Heart J 2011; DOI:10.1093/eurheartj/ehq465.

Dauchet, L., Amouyel, P., Hercberg, S., Dallongerville, J. (2006). Fruit and vegetable consumption and risk of coronary heart disease: a metanalysis of cohort studies. Journal of Nutrition, 136(10):2588-2593.

Glass, T.A., McAtee, M.J. (2006). Behavioural science at the cross roads in public health: extending horizons, envisioning the future. Social Science and Medicine 62:1657-1671.

Marmot, M.(2005). Social determinants of health inequalities. Lancet, 365:1099-104.


  1. Your primary message seems to be that complex messages can be made simple, but I think that a complimentary point is that THE PROBLEM (i.e., healthy living/diet) ITSELF is complex. Thus, it is not simply a matter of 'presentation', but a matter of complexity itself. To that end, I'm curious as to why anyone should believe that any central authority (with the same limitations of perfect knowledge as any other 'expert') should be given the task of providing THE message. That is to say, why should this be the state's job to tell people how to eat. (To clarify, I'm not arguing here about the proper role of gov't, but whether the state is even fit for such a function any better than other sources of information).

    To further make the point, in your opening you describe a number of sources of information. If I understand you right, I assume that this--in your mind--should be organized and presented from a central authority. It touches on a much larger issue as to the role of state-run/funded health all together.

    So, Q#1: To what extent is the state a better source of information than other sources. (By the way, I'm not setting up a straw-man argument that suggests that we should listen to anyone, but instead, focusing on why should this be centralized AND believe that we get better information?).

    Furthermore, to your point w/the limits of self-regulation. I'd like to see some data that shows that low SES are more socially excluded and thus have lower self-regulation capacity. I know the link b/t social exclusion and self-regulation. It is the first connection that I challenge.

    Q#2: Is there any merit to the idea that Low SES are more socially excluded?

  2. Hey Michael, thanks for commenting. Great questions. I see that I have an in text citation but not a reference for the social exclusion in low SES. I will rectify this immediately. I think there is no question that people of low SES are more socially excluded.

    If you search on social capital you will find a large amount of research that substantiates that part of my argument. However, I do not think there is much, if any research that establishes social exclusion in low SES to low self regulatory capacity. This would be a hypothesis I would like to explore. However, there is a strong link to academic performance, SES and social capital. I believe this makes my argument plausible. But I am eager to get your thoughts on that.

    As far as state-run health care is concerned would love to have that discussion at some point but I think it would be too much typing for this format.

    Thanks for your criticisms,