“Our goal is to stimulate a constant and positive behavioral change, focusing mainly in the areas of health and environment”
“We know that people need incentives or rewards tochange their behavior”
Dozens of E-Health professionals & innovators attended the II MIHealth Forum that took place in Barcelona during the 21st and 22nd of May, earlier this year of 2014. Among them was Ron Dembo, the driving mind behind Zerofootprint: and initiative that seeks to encourage citizens to be cleaner towards their environment and towards their own bodies. Because if “old habits die hard”, why not provide incentives to change them into new, better ones?
How would you define Zerofootprint to a novice?
RD.- We are a company that changes behavior of people to the positive. Our goal is to stimulate a constant and positive behavioral change, focusing mainly in the areas of health and environment, which both require a wide, common effort from people to improve everything from little aspects to the wider picture. When people ask me for more details about Zerofootprint, what I usually say is that, in a typical scenario like a hospital, a building, a national health system or a particular environment etc. 50% of the problems or issues of that scenario may be caused by structural or technological aspects, but the other half is usually caused by everyday behavior, which is usually the side of the problem that is ignored or overlooked. Focusing on the health aspect, what we usually do is buy more machinery or build larger hospitals, but most of that expenditure can be avoided by changing habits.
SH.- In what countries or regions has Zerofootprint established itself, and what kind of responses have you got?
<pRD.- Since the idea behind Zerofootprint is quite new, we have established a first firm contract with Barcelona with the intention of starting a pilot project here, although we are in conversations with several other organizations and institutions. Specifically, the subject that I talked about at the II MIHealth Forum in Barcelona received a lot of interest. I discussed the need to establish a social awareness about reducing healthcare expenditure, not by budget cuts, but by patients needing less visits to their doctors after switching to healthier lifestyles.
But we also had a very big reception in Toronto and other Canadian cities, because Canada has made a lot of progress in terms of environmental awareness and carbon reduction, getting people to change their attitude around energy, and that was the first area of development in which Zerofootprint started working. We got a lot of people to measure their environmental impact and many initiatives quickly engaged the people, having reached tenths of thousands of Torontonians signing up for different initiatives and programs.
SH.- What kind of tools does Zerofootprint offer to the people, so they can change their habits and help themselves become healthier?
RD.- We are working with several measurement different devices, like subcutaneous glucose measurement, or several mobile applications that can be used from cellphones, so that people can check their own constants. Even clothes, like a T-shirt developed in Canada that registers the expansion of the chest to monitor breathing and heartbeat. We also encourage proactive behavior, like jogging and making better purchase choices in the supermarket.
Of course, collecting and analyzing this data can yield other results for the city in terms of urban planning. For instance, in Barcelona it is easy to encourage biking, because a lot of roads are already prepared for them, and it is a two-fold benefit: for the health of the citizens, and for the reduction of carbon emissions of the city. Without invading any kind of privacy, if we monitor the usual routes, we can create data that show where the most used biking routes are, and city planners can use that data for future projects.
SH.- You talk about changing the behavior of individuals, understood as a change in lifestyle, as the key to health rearrangement in the future. Can this change be globalized? Should this behaviour be the same in Boston as in sub-Saharan Africa?
RD.- The answer is yes, and our intention is to do this globally. However, behaviour change and the nudges that are needed will differ in different cultures. Even if we were to take Boston alone, the population that we might address needs to be segmented and the nudges to induce behaviour change would be different for different segments and even more so if we compare Boston and sub-Saharan Africa. One constant is the underlying software used to do change on a large scale. But the specific way we approach different groups would be culturally sensitive.
SH.- In contrast to other prevention tools and treatments, you designed a digital currency called Goodcoins that can be traded in for goods & services. How did this idea come to mind?
RD.- It´s a matter of reverse engineering… After all, we know that people need incentives or rewards to change their behavior, and those rewards often work better when they are intrinsic instead of extrinsic. To put it in another way: if we rewarded someone with a normal currency, the good that was created by the positive activity engaged can later be mitigated if that reward, that price, goes to something unhealthy or environmentally negative. With schemes such as that, there is no way to truly know whether the result will be positive. However, if that currency is used in a system of supervised, beneficial, healthier or simply “good” rewards or services, the final outcome will always result in an overall positive change.
SH.- Many countries in the world, such as Spain, are facing a steadily aging population. This will result in growing treatment and medication costs for the people and the governments. Can preventive solutions like Zerofootprint help on this matter?
RD.- Yes, indeed. Spain, a country that I know well, is a very good case. The current elderly population, for example, grew up in an age where smoking was very popular, and these people suffer many chronic respiratory problems. On the other hand, whereas these people grew up with very healthy diets, the younger generations have started eating more and more fast food, which will lead them to obesity or circulatory problems in the future. There are also some environmental issues in Spain: when I went to Madrid in 1995 I was astounded at how bad the air was in the city, and the aging population in a city like this may be subject to pneumonia and other diseases. What we do know, however, is that even if these people were not being affected by these external poisons, healthy habits like regular exercise, a balanced diet and giving up smoking could help them a lot. In particular, most of the researchers I have spoken to believe that the health benefits of adopting these habits could lead to a 50% reduction in recidivism [a patient needing to receive treatment twice or more because of the same problem, because it hasn´t been solved].
Behavior change is not deterministic. By that I mean that even by adopting the lifestyle habits that I have outlined, a total possibility of change cannot be guaranteed, because there are some factors that come into play which are out of the patient´s control, like genetics and environmental/external elements. But what we can say for sure is that, when applied to a larger population, statistics show that behavioral changes are effective and the shifts are significant.
SH.- Another strong problem that Spain faces right now, and that has negative health consequences, is sedentism. Does Canada face similar problems?
RD.- Yes, this is also a problem in Canada because a lot of people have adopted bad eating behaviors (in fact, I believe that European countries in general have healthier diets than Northern American states). However, even in that regard, I think that sedentary behaviors are worse in Spain that in Canada, because people are so much less active… I didn´t see many people doing exercise or simply taking a walk out in the streets. In fact, at that time (1995) joggers were looked at strangely by other bystanders. Out of the local people that I was working with at the time, none of them did any exercise.
However, sugary and fatty diets have grown in popularity in Canada and obesity has become a real problem, reaching a whopping 65% in certain regions and causing a surge in diseases like diabetes. We have a section of our population which is susceptible to these diseases, and these areas sometimes have another common trait, which is the lack of pedestrian routes or zones in which people can have a walk (most of them are forced to use cars to go from point to point).
SH.- Zerofootprint emotional "core business” is the commitment with the advancement of society. Tellme three reasons that make Zerofootprint different from other organizations...
RD.- We have a strong commitment to scientific and evidence-based change that is auditable. We believe that big data is essential, not just another app.
We cut across all aspects of an individual’s life, their health, environmental behaviour and community. We bring all that together under one single umbrella, GOODcoins. A product that leverages the GOOD in society.
We do initiatives that have a strong social value but with no necessary link to our business. For example, the retrofitting of buildings through our “Reskinning Awards”