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Culture Change and NYC’s Soda Ban

September 13, 2012
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Does transformation come at a price?

Whenever the topic of change in healthcare comes up, so many leaders in this industry talk about how it all comes down to transforming the culture. Whether it’s physicians, patients, payers or anyone else, real positive change comes through a long-lasting overhaul of behavior. I’ve heard and read it so many times that I’ve stopped taking count.

Take for instance, this blog from strategy consultant Leonard Kish, where he argues that engaged patients and coordinated care-providers are the best drug you can in improving clinical outcomes. Yet at the end, Kish warns, the path to engaged patients and coordinated care is a “cultural and behavior change.”

There’s more where that came from. Implementing a strong social media platform that can engage patients? As HCI Senior Editor Jennifer Prestigiacomo reported, it comes down embracing it as a mindset. Creating, coordinated, population-health based care delivery? As Evan Benjamin, M.D., senior vice president and chief quality officer of Baystate Health in Springfield, Mass., told HCI Editor-in-Chief Mark Hagland, it’s going to be a long journey for a provider.

Even something as small as changing a patient’s preferential method of contact to something more modern like text messages or emails, as Richard Ferrans, M.D., vice president and chief medical officer at Presence Health recently told me, has generally not been done over privacy and security concerns. These are just some of the examples I was able to drum up in a few minutes, of everyone saying pretty much the same thing. This idea, that healthcare’s change is a culture-based, long transformation, is everywhere.

While we’d like to believe an information system can come in and fix everything, everyone knows that just isn’t true. An EHR, patient portal, HIE? These systems are just a piece of the puzzle when it comes to changing how healthcare is delivered.

And why is this on my mind, right now? Two words: soda ban.

In New York City, where I work and live, it’s a hot topic. Recently the New York City Board of Health voted to support the ban on large, sugary drinks 16-ounces and over in public places like movie theaters, a law pushed by Mayor Michael Bloomberg. The ban, set to take effect next year, has been highly controversial, with people vehemently arguing for and against it. Interestingly, most people are against the ban, according to most public polls.

To be honest, I have no strong feelings about the ban. I don’t drink soda, I’m too cheap to buy drinks when I go to the movies or a sporting event, and I try to avoid fast food restaurants whenever I can. If there are no 16-ounce sodas in this city for me to drink any more in a public place, I think I’ll be okay. 

However, the ban made me wonder: what role does government play in changing behavior, and can it overstep its bounds? We all know there is a severe obesity problem in this country. That’s not opinion, it’s fact. The most recent numbers are embarrassing. More than one-third of adults are obese, obesity related chronic illnesses are among the leading causes of preventable death in this country, and obesity affects 17 percent of children, triple what it was one generation ago.

Dire numbers aside, I’m not sure a somewhat limited ban is the right method of creating a culture change. After all, if you really wanted more soda, couldn’t you just buy two 12-ounce cups? Also, what about buttery popcorn, baseball hot dogs, and McDonald’s Big Macs? Are those next? Then again, it’s hard for me to think of what would be a good alternative, other than the public programs that are in place right now.

I like what Jeffrey Mechanick M.D., a professor at the Mount Sinai School of Medicine, said to the AP, regarding the ban, in what I would call a quasi-defense. He said, individually attacking one thing won’t do much. However, as part of a more widespread culture change, it could help build awareness, similar to what happened with smoking.   Of course, critics of the ban would say at what cost? Does fermenting a culture change allow the government to regulate what to eat and drink? Even cigarettes aren’t banned, just where you’re allowed to smoke.

Ultimately, I think, getting people to take better care of themselves is something that they will have to take on. Getting them to be healthier, or more engaged in their patient care, are complex problems that will take a long time to fix. Just as a patient portal won’t solve things over night, neither will a soda ban.




This is not a new idea...first heard it in 1975. Still gets play every once in awhile. But then it fades, as it will in NYC. It fades because as you point out where do you stop? No more extra large pizzas? Eliminate half the cabs in NY - better they walk...and so on.

Now here's the real irony. If we don't want people to consume so much sugar, stop subsidizing the sugar industry, and the farmers who grow corn. If we wnat people to exercise more cut back on cars (like why bailout GM?), and so on.

As the great philosopher Pogo once said. We have seen the enemy and he is us!

Frank Poggio
The Kelzon Group

Thanks for your comments Frank!