Seeking Effectiveness

If you want to lose faith in the ability of the 5-A-Day program, the new Fruits & Veggies — More Matters! program or any public health program, go to the M.D. Anderson Cancer Center in Houston, TX, one of the planet’s premier institutions for the research and treatment of cancer.

In the cafeteria, you will watch a group of hospital employees, exposed to the effects of poor eating habits on health with an intensity far beyond that which the general public will ever be exposed to. You will see bulletin boards and table tents promoting 5-A-Day and other healthful eating programs plus seminars and other supportive programs — a communication and repetition of messages far in excess of anything we will be able to duplicate in the general public.

You will also see the very lengthy line for chicken fried steak, macaroni and cheese and the Chick-fil-A franchise.

Observe closely and you will note the body mass index for the employees is not noticeably different from the girth you would expect for people of similar socio-economic status in other professions. Though the data is not available to say definitively, I would hazard a guess that the employees here are in slightly worse shape than comparable people in the population at large.

Why? Perhaps their high-stress jobs in a world-renowned cancer center, positions in which weekend work is generally mandatory and where night shifts are common — perhaps all these factors define the parameters in which people live their lives to such a degree that these pressures outweigh the benefits employees may have in wisdom or knowledge.

Put another way, maybe what is wrong with 5-A-Day isn’t the slogan or even the budget. Maybe public health messages are just a very difficult tool to use to change eating habits.

It reminds me a little of the issue of population control. Although tremendous effort goes into lecturing about family planning and distributing contraceptives, it is mostly for naught. Yet, whenever a country joins the developed world when incomes are high and infant mortality low, when each child requires enormous investments in education and when pension and social security systems provide some assurance of sustenance in old age, the rapid and certain consequence is a collapse of the birth rate.

The implication of this is that direct effort sometimes may not be as successful as indirect effort. If you want to reduce population growth, spending your life lecturing on family planning is not half as likely to be as effectual as devoting your life to increasing the prosperity of poor countries.

Look at the data in the table below. Makes you wonder if we might have more success at increasing produce consumption by devoting our efforts to increasing the education level of the general population than if we devote ourselves to preaching the 5-A-Day message. Maybe not. Maybe education level is a rough proxy for some other factor, such as IQ, and no amount of schooling will change that. We don’t have enough data yet to tell us for certain. But it is something we desperately need to explore.

The point is, we ought not just barrel ahead assuming we are accomplishing something just because we are doing something.

It is easy to assume hard work is the key to success. Yet in observing this industry for more than 20 years, I find it pretty clear that this isn’t the whole story by a long shot. In fact, if it is so hard to accomplish something, it may be a sign you are swimming upstream and need to find a different approach.

The United Fresh Fruit and Vegetable Association and the International Fresh-Cut Produce Association announced a merger. It has been talked about for years. Now it is happening. Somebody could sit down and write a list of all kinds of opportunities. Perhaps the merged entity will build up the fresh-cut show into a major event serving suppliers. Perhaps, with better resources, they will have something to offer international firms, and membership will boom. Perhaps they will expand the focus of the association and bring in producers of wet salads and various other food products.

Or perhaps all these things are too hard, and achieving these goals may not be worth the effort. So perhaps nothing will happen, and the merger is just the final acknowledgment that fresh-cuts are not a separate industry anymore; they are just another product sold by produce companies. So just as some companies sell potatoes and onions or apples and pears, companies such as Dole and Chiquita now sell bananas and fresh-cuts.

It would be churlish not to congratulate the boards and staff of both associations. They made something happen and should get credit for it.

But it would be foolish to pretend that an action such as a new branding campaign for 5-A-Day or a merger of two trade associations actually substantively solves the problems of the industry.

There are so many well-meaning and hard-working people trying to make things better for this industry. We are truly blessed. But it would be a shame to let people work so hard and to spend so much money without recognizing that we need to do more than do something — we need to find the path to effective action.