Shifting the curve

The cyclists in Melbourne are mad. Seriously! As a start, they bike on the wrong side of the road… They travel at a crazy speed on their racer bikes and they all wear bicycle pants and colourful tops. They also wear helmets, which is required by law and a good thing I think, although it won’t save the pedestrians in these guys’ ways.

There seems to be an unwritten rule that only REAL cyclist, according to the description above, can use the bike lanes on the road. The rest of us should stay on the pavement. I enjoy my Melbourne shared blue bikes tremendously and get the nastiest stares from the REAL cyclists as I pedal away in the bicycle lane, wearing office clothes, mounted with a computer bag, and other inconvenient accessories.

But I am a public health person and I know that having a tiny elite ruin their joints with excessive biking will not help the population reach a better health. So I am intending to keep breaking the unwritten code of Melbourne cyclists who may continue to shake their heads at me – santé!

Because what we are trying to achieve in public health is shifting the curve, as we say. With many people making small changes in their lifestyle the sum of the effects can be tremendous for the health of the population as a whole. On the contrary, if relatively few people make drastic changes, the population, as such, will still not improve because the effect gets diluted.

Geoffrey Rose was a prominent person in public health and he introduced what is called a “population approach” to health (Sick individuals and sick populations, 1985). He was the one who coined the term “shifting the curve”, of which you can see an illustration here. What it means is that we need to redistribute the values of a certain outcome, such as blood pressure, in the population in a way so that everyone gets better values and as few as possible have sickly high or low pressures.

JNC7-Public-Health-Strategy

I am tremendously inspired by Rose’s work and in a recent article we attempted to take his ideas further in the context of child behaviour problems. We are trying to say that if the goal of public health is to shift the curve – well then we should look at the results of our interventions by examining the curve and not using tools developed for clinical trials. I have discussed this idea with several prominent public health people at the conference and tomorrow I will meet a big name in our field, who will hopefully be able to tell me if our idea is great or worthless.

Rose was lucky enough to have been appreciated during his lifetime, although I am sure he had his adversaries. That was not the case for many other scientists. This morning on the way to school I told Joel the story of Ignácz Semmelweis, whose ideas had not been accepted by his contemporaries. Joel was horrified by the way Semmelweis had been treated, but was extremely satisfied to hear that he had been right all along, saving hundreds of women from dying in childbirth. I had to tell him the story several times and he wanted more and more details. The greatest discovery in medicine is, indeed, prevention. Let us all do our bit in shifting the curve!

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