Resources also ‘develop’ in noncommercial situations. Staff chains work exactly as for business cases, but demand-drivers also develop, for example when political parties try to move voters from apathy to interest and then support. Not all developments are desirable, though, and must be deterred rather than encouraged. Today’s criminals previously moved through increasingly serious levels of antisocial and illegal activity, often at a young age, before becoming known to police.
One public policy case concerns the rising prevalence of Type-2 or “adult-onset” diabetes. The disease does not just strike overnight, but arises after individuals have spent some time in a prediabetes state, when blood glucose levels exceed normal but do not climb high enough to trigger a diagnosis. Genetic factors play a role in determining who develops prediabetes, but obesity is also a risk factor. It is possible with weight loss to recover from prediabetes and move back to a situation where glucose is again in the normal range. Excess weight can also speed the progression from prediabetes to the full disease.
Full diabetes marks the point at which the progression of the disease becomes irreversible, and damage to small blood vessels starts to occur. Diabetes can, though, be effectively managed with proper medicines and monitoring, and with improved diet and exercise. At some point it may become necessary to start injecting insulin. Many sufferers develop secondary complications, such as heart disease, kidney failure, blindness or amputation.
Figure 1 shows a four-stage chain of this progress, together with historical and projected information for the number of American sufferers. The chain is somewhat simplified, by not separating those who do not yet know of their condition from those who do. The structure also leaves out, for simplicity, population inflows from aging and immigration, and outflows from emigration or deaths from other causes.
Figure 1: Progression of people through stages of diabetes. (click to enlarge)
Source: Reproduced by permission of Andrew Jones and Jack Homer.
The prevalence of diabetes has grown strongly since 1980. Policy options include:
- Improved treatment for those with complicated diabetes, with immediate benefits of improved health and productivity, fewer hospitalizations, and a net reduction in costs.
- More effort to detect and manage people with uncomplicated diabetes. This implies immediate cost but no immediate benefit, expenditure must be viewed as an investment with the pay-off coming in later years, through reduced disease progression and thus lower medical and productivity costs.
- Efforts to detect and manage prediabetes, when simpler and cheaper interventions emphasising diet and exercise, may prevent onset of diabetes and its associated costs. Again, this involves immediate costs but later savings.
Efforts to reduce the general prevalence of obesity in society, and thereby reduce the onset of prediabetes and of diabetes.
Figure 1 summarizes likely outcomes from combining two policy responses — greater detection and management of prediabetes, and reduction in obesity. The upper timeline labeled “Base” shows expected numbers of people with diabetes if neither response is implemented. The solid green line shows the reduction achievable by management of one-third of prediabetes cases alone. The dashed green line shows the much additional success that is possible if health and social policies manage to reduce population obesity to 25 %.
Until next time…
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Adoption of sustainable behaviours
The choice pipeline from Briefing 40 also has parallels in many cases where people need persuasion to adopt some change. Many nations want to reduce greenhouse-gas emissions to slow climate change, and contrary to popular belief, this does not require new technology, so much as adoption of well-known existing methods. Nor is it costly – 25% of emissions can be eliminated at a profit, and over 60% at no net cost to the global economy (see McKinsey analysis). Getting these opportunities adopted is not therefore a technology problem, or even an economic one – it’s a marketing challenge for which the choice pipeline provides the framework to develop a strategy.
This briefing summarises material from chapter 6 of Strategic Management Dynamics, pages 398-404.
Read more about the book on the Strategy Dynamics websiteShare