donuts are everywhere we live in a land
of too many donuts
there are Krispy Kremes and cronuts and
Dunkin Donuts thousands of Dunkin Donuts
coast-to-coast right although you’re not
supposed to call them Dunkin Donuts
anymore they drop the donuts part last
week but doughnuts are everywhere right
we love doughnuts
literal doughnuts these kind of
doughnuts and metaphorical doughnuts I
would define doughnuts I’ll offer a skew
to define doughnuts as things that we
find irresistible that appeal to our
base instincts that we can’t quite turn
away but may not be good for us in the
end or especially in volume so people
who make donuts both virtual donuts and
real donuts they know this okay they
know what they’re doing and they know
they’ve got us
Greg maura a product manager at Facebook
was describing the Facebook donut
problem and talking about the newsfeed
right the newsfeed and he was talking
about it like this he was saying if you
just watch people eat donuts you’re like
people love donuts let’s bring them more
donuts but actually people might want
everyone smile is not a donut but a kale
smoothie
in which case Facebook thought maybe we
can give them some kale smoothies too
well they’re working on that right
they’re working on on their doughnut
problem but what’s true at Facebook is
true so many other places right it’s
true in our food system literally it’s
true in our cars it’s true in our
entertainment it’s true in about our
one-click shopping and two days shipping
all for free so me seemingly as their
Donuts social media that is actually has
the effect of making us anti-social
donuts and cities that are designed for
cars instead of the people those are
donuts
doughnuts as I said are everywhere so we
live in this world right and it has been
exquisitely designed perfectly
engineered to cater to our base
instincts right to placate our fears to
beguile us into having just one more
that’s the world we live in but it’s not
good for our health it’s not good for
our physical health it’s not good for
our mental health it’s not good for our
social health and we can’t blame the
individuals for this right this is the
world we’ve created
you can’t blame 200 million Americans
who might be overweight or obese or
suffer from depression as if they have
some kind of moral failing right it’s
not on them it’s on us this is the world
we’ve designed in fact if you look at
the four cornerstones of our modern
civilization what I would call the food
supply
shelter our homes and communities are
transportation networks our
entertainment all of them really have
the net impact of hurting our health
rather than helping it right they all
have this default mode that leads to
poor health if you look just at the
average American ok the experience of
the average typical everyday American
there is no such thing but let’s just
pretend they make $34,000 a year ok they
pay about $1,300 a month in rent clearly
the average American does not live in
San Francisco they they commute about 30
minutes each way to work so 1/2 hour
their half hour back they watch about 10
hours of screen time a day on average
so that’s smart phones computer screens
and TVs and they consume on average this
average American they consume about
3,600 calories a day even though the
average American on average needs only
2,500 calories per day so that’s the
typical default experience and what does
that lead to okay what is that default
average experience lead to well let’s
look at it first here’s your house
here’s the average house here’s your car
here’s your desk looks charming here’s
what you eat and here’s where you go for
fun here’s what you do for fun you go to
your kitchen which of course has a
big-screen TV right
this is where we spend all of our time
there’s a reason our kitchens and our
bathrooms are the biggest rooms in our
houses now it’s because that’s where we
spend our time
it’s where the food goes in and where it
comes out so so that’s that default mode
that leads to this right it leads to
what we could call the seven plagues of
modern life and they break down like
this obesity diabetes heart disease
those are really consequences of the
body overwhelmed chronic pain mental
illness and drug abuse those are the
body saying stop right look body looking
for an out and autoimmune diseases the
more than 80 different conditions that
like Crohn’s or IBS that are represent
when the immune system is actually
malfunctioning those really are the body
pushing back fighting back against
itself so if that’s what’s going on we
have to realize what this is a
consequence of 50% of Americans suffer
right now from one of these conditions
and half of the people in this room are
going to die of one of these conditions
this is the world we’ve built but this
is not I would argue the human condition
right this is not inevitable this is not
just what happens since we’ve gotten rid
of most infectious diseases it’s not
just how the body is supposed to die
we’re supposed to decay in fact it goes
in many ways contradicts our basic
biology Daniel Lieberman an evolutionary
biologist at Harvard talks about those
conditions those seven plagues as
mismatched diseases where we’ve actually
put our body in a context for which it
is not suited on an evolutionary basis
and that is in fact the consequence that
we’ve designed when you think about it
the the average American going from that
that default mode into this zone they
they actually let me just get my tracker
fault again oh so so the these are these
the burden of disease this burden of
disease these seven conditions they
actually affect the poor and the
powerless far more than the wealthy and
well-off all right but they affect all
of us this is actually the world we all
live in so what do we do we spend about
two hundred billion dollars on
prescription medications just to treat
these conditions
we spent about two hundred billion
dollars in hospital costs per year to
care for people in hospitals with these
conditions about thirty billion dollars
on drug abuse treatments a year and
Americans spend about seventy billion
dollars on diets that’s an even half
trillion dollars the diets that kind of
stuff works for some people right
it works on a one-on-one basis people
who are going paleo or going gluten-free
in some sense they’re they’re kind of
trying to turn back the clock to this
world before the world we’ve created and
it works for some of them right you
certainly to get an earful if it does we
all hear about it but it doesn’t scale
right this is not a way to fix the
problem so I spent about the past twenty
years twenty years of my life
thinking about how we use data and
design to tell stories to tell stories
that could help people make better
decisions often about health and I spent
about the fast five years I did that at
Wall Street Journal any of that it wired
for about a decade and now I’ve spent
past five years working on healthcare
technologies trying to build the tools
that could help people with better
decisions and that time I’ve seen
billions of dollars invested in
healthcare right it’s a big wave but the
problem is it’s going at the wrong end
of the pipe right it’s going to where
the money is that half trillion dollars
but it’s not going to where the problem
is we have to think about what different
stories we could tell I believe we have
a different story we could tell about
our cities and our communities and our
civilization this is not a problem for
government this is really a problem for
the people in this room this is a
challenge to people in this room an
opportunity Buckminster Fuller the the
fellow behind the buckyball you you
heard about earlier but Windsor Fuller
was one of the crazy radical designers
of the 20th century and is an
inspiration to me I named my kid after
him he challenged us not just to think
bigger
he posited this question how big can we
think what is the capacity of us to
engage in the hardest problems that face
mankind face humanity and in this case I
believe we face a very big challenge
indeed I think we have to do nothing
less than to rebuild civilization
all right redesign it reengineer it so
that the default leads to health he gave
us a strategy to but brinster folder
talked a lot about how the best way to
approach problems is not to reform few
people but to reform the environments in
which we live all right that’s the way
to get things done so let’s apply some
buckminster fuller thinking and think
about these four areas of our
civilization okay our food our shelter
transportation entertainment the first
strategy that I would suggest is that
people who are creating new products who
want to design for health who must
design for health we try to make this
irresistible right we try to make the
healthy choice irresistible we want
things that don’t just make people feel
like they’re doing better but actually
are better for them right we want to
exploit the defaults we want to think
about nudge theory and other tools that
we can do to make the Healthy Choice the
easy choice and third we want to sweat
the logistics health is I always say
this health is a logistics problem not a
science problem it’s a matter of
delivering the right goods and services
and care to people at the right time
that’s the none and so to tackle this
problem we need be thinking about what
we’re creating and what we’re building
not just in three dimensions but in
force four dimensions I’ll give you
example what I mean for companies
someone I’m gonna run through some
examples of companies that I think are
doing this now first is appeal sciences
there’s this amazing company that’s
taking this problem of access to food
access to healthy food ok it’s a problem
a lot of people have talked about and
traditionally the approach is to build
more grocery stores in neighborhoods
right to increase access by building
stores what appeal Sciences is doing is
they’re taking an other approach they’re
taking a fourth dimension approach and
thinking about time they’re actually
making healthy good nutritious food last
longer so they don’t what when it does
become available to people it’s there
and on the Shelf longer in a healthy
state that’s food in entertainment our
point is to Niantic labs so an antic
labs is a company that’s behind a
company a lot of or behind a video game
a lot of you’ve heard of called Pokemon
go right this was a huge phenomenon a
couple years ago and the
lot of people thought it was just a fad
right this engaged gaming where people
get out into their neighborhoods and
start spelunking and trying to pick up
whatever they were trying to pick up
that was a huge fad but this picture
here is from this year this is still
going strong Pokemon go this was in
Santa Monica this summer and importantly
Niantic is now taking these same
principles engage gaming to a new game
that’s going to come out any day now
it’s the new Harry Potter game and that
I think is a big deal because it’s gonna
change how our children think about
video games and entertainment it’s gonna
make moving part of the proposition in
shelter I want to point to Ori systems
Ori systems is this amazing company
that’s using robotics that turn small
spaces into multifunctional spaces so
that a living room can transform into a
bedroom and back to a living room with
just the touch of a button and this is
going to change not just individuals
lives right how we are we kind of work
in our spaces that are live in our
spaces but it’s going to transform
communities because it’s going to allow
us to live in higher density
environments and have more contact with
our friends and family and in
transportation I want to point you to
lift now we’ve all heard about lift and
and you might think of them as just the
good guys in car sharing but they’ve
actually done some amazing things in
just the last few months starting in
July they started they bought a bicycle
company so now they rent bicycles right
that’s part of their service they now
have East scooters built into the system
who doesn’t have a nice scooter startups
these days but they do too and finally
they’ve done this they’ve started to
build public transportation into their
app so that I’ve taken public transit is
the best choice they want to nudge you
towards that choice and you might have
to walk a couple blocks but that may be
the most efficient way to get there this
I believe is a big deal so we need more
examples right those are some some
worthy examples but we need more
examples I want this room to be the
place where more examples emerge so I
want you to ask yourself is my company
or product or organization building for
health or is the net impact of it going
to be more illness more more passivity
I’m going to give you a checklist of
five questions
five questions you can ask yourself and
evaluate what you’re doing right and
evaluate the companies and services that
you buy by this checklist the first one
is does it reduce the time does my
product or company or service does it
reduce the amount of time that people
spend alone right is an increase a
solution or reduce it does it help
people move more does it get them
outside is it good for me and good for
my friends or family and community right
is it not just an I win and you lose
situation as so many products are here’s
a good one does my product make people
feel better after they use it and
finally do people benefit more the more
they use it right now I’ll give you a
very simple way to think about this
checklist it’s a it’s a one-stop rubric
I’m gonna call it the doughnut test okay
this is a application of one of my
favorite little principles in economics
it’s called the marginal utility curve
it’s a very simple way to measure the
value or benefit we get out of something
per unit per unit of a good or service
right so so bang for the buck so to
speak and in the case of donuts right
that first don’t on taste great right we
get a lot of pleasure out of that first
doughnut partly because we know we
shouldn’t be eating it but it gives us a
lot of pleasure
the second doughnut not so much right we
still finish it we still eat the whole
thing but it’s not as satisfying as the
first one and by the third and fourth
and fifth donut
we’re actually chipping away at any
value we get we have to think about our
companies we create the companies we use
the products we use according to the
donut test do they yield a net benefit
or a net negative so this is a concept
in an idea that I’ve been thinking about
a lot over the last years and we are now
starting to turn it into an organization
in the community we’re calling a
building H it’s something that I’m doing
with my friend Steve Downes who’s from
the Robert Wood Johnson Foundation Steve
talks about health not as a vertical
market but as a horizontal value and I
think that’s something that we all need
to think about how can we internalize
this proposition of
building health into everything we do I
want to leave you with four examples of
how we’ve done this before right this is
a big deal I know it’s silly and almost
crazy to talk about rebuilding
civilization but we can do it it is
within our means 2,000 years ago the
Romans built aqueducts across hundreds
of miles of the Roman Empire bringing
fresh water clean fresh water into their
cities 200 years ago the cities of
Europe and North America they were torn
up really remade for public sanitation
right to make sure that people had safe
environments and safe neighborhoods that
they could use in living transformed the
way we think about cities 20 years ago
transportation engineers in the United
States got religion finally about
bicycles and they started to build in
networks of bike lanes throughout our
cities now I biked in San Francisco
we’re not there yet we have a lot of
lanes to build but we’ve made a human
tremendous progress over the last 20
years and just two years ago
Google’s sidewalk labs started a pilot
project in Toronto where their Rican
sieving the whole city to be built
around the principles of sustainability
and health so that’s two thousand two
hundred twenty and two years ago today
it’s your turn today it’s our turn to
start building health into everyday life
thank you very much [Applause]
of too many donuts
there are Krispy Kremes and cronuts and
Dunkin Donuts thousands of Dunkin Donuts
coast-to-coast right although you’re not
supposed to call them Dunkin Donuts
anymore they drop the donuts part last
week but doughnuts are everywhere right
we love doughnuts
literal doughnuts these kind of
doughnuts and metaphorical doughnuts I
would define doughnuts I’ll offer a skew
to define doughnuts as things that we
find irresistible that appeal to our
base instincts that we can’t quite turn
away but may not be good for us in the
end or especially in volume so people
who make donuts both virtual donuts and
real donuts they know this okay they
know what they’re doing and they know
they’ve got us
Greg maura a product manager at Facebook
was describing the Facebook donut
problem and talking about the newsfeed
right the newsfeed and he was talking
about it like this he was saying if you
just watch people eat donuts you’re like
people love donuts let’s bring them more
donuts but actually people might want
everyone smile is not a donut but a kale
smoothie
in which case Facebook thought maybe we
can give them some kale smoothies too
well they’re working on that right
they’re working on on their doughnut
problem but what’s true at Facebook is
true so many other places right it’s
true in our food system literally it’s
true in our cars it’s true in our
entertainment it’s true in about our
one-click shopping and two days shipping
all for free so me seemingly as their
Donuts social media that is actually has
the effect of making us anti-social
donuts and cities that are designed for
cars instead of the people those are
donuts
doughnuts as I said are everywhere so we
live in this world right and it has been
exquisitely designed perfectly
engineered to cater to our base
instincts right to placate our fears to
beguile us into having just one more
that’s the world we live in but it’s not
good for our health it’s not good for
our physical health it’s not good for
our mental health it’s not good for our
social health and we can’t blame the
individuals for this right this is the
world we’ve created
you can’t blame 200 million Americans
who might be overweight or obese or
suffer from depression as if they have
some kind of moral failing right it’s
not on them it’s on us this is the world
we’ve designed in fact if you look at
the four cornerstones of our modern
civilization what I would call the food
supply
shelter our homes and communities are
transportation networks our
entertainment all of them really have
the net impact of hurting our health
rather than helping it right they all
have this default mode that leads to
poor health if you look just at the
average American ok the experience of
the average typical everyday American
there is no such thing but let’s just
pretend they make $34,000 a year ok they
pay about $1,300 a month in rent clearly
the average American does not live in
San Francisco they they commute about 30
minutes each way to work so 1/2 hour
their half hour back they watch about 10
hours of screen time a day on average
so that’s smart phones computer screens
and TVs and they consume on average this
average American they consume about
3,600 calories a day even though the
average American on average needs only
2,500 calories per day so that’s the
typical default experience and what does
that lead to okay what is that default
average experience lead to well let’s
look at it first here’s your house
here’s the average house here’s your car
here’s your desk looks charming here’s
what you eat and here’s where you go for
fun here’s what you do for fun you go to
your kitchen which of course has a
big-screen TV right
this is where we spend all of our time
there’s a reason our kitchens and our
bathrooms are the biggest rooms in our
houses now it’s because that’s where we
spend our time
it’s where the food goes in and where it
comes out so so that’s that default mode
that leads to this right it leads to
what we could call the seven plagues of
modern life and they break down like
this obesity diabetes heart disease
those are really consequences of the
body overwhelmed chronic pain mental
illness and drug abuse those are the
body saying stop right look body looking
for an out and autoimmune diseases the
more than 80 different conditions that
like Crohn’s or IBS that are represent
when the immune system is actually
malfunctioning those really are the body
pushing back fighting back against
itself so if that’s what’s going on we
have to realize what this is a
consequence of 50% of Americans suffer
right now from one of these conditions
and half of the people in this room are
going to die of one of these conditions
this is the world we’ve built but this
is not I would argue the human condition
right this is not inevitable this is not
just what happens since we’ve gotten rid
of most infectious diseases it’s not
just how the body is supposed to die
we’re supposed to decay in fact it goes
in many ways contradicts our basic
biology Daniel Lieberman an evolutionary
biologist at Harvard talks about those
conditions those seven plagues as
mismatched diseases where we’ve actually
put our body in a context for which it
is not suited on an evolutionary basis
and that is in fact the consequence that
we’ve designed when you think about it
the the average American going from that
that default mode into this zone they
they actually let me just get my tracker
fault again oh so so the these are these
the burden of disease this burden of
disease these seven conditions they
actually affect the poor and the
powerless far more than the wealthy and
well-off all right but they affect all
of us this is actually the world we all
live in so what do we do we spend about
two hundred billion dollars on
prescription medications just to treat
these conditions
we spent about two hundred billion
dollars in hospital costs per year to
care for people in hospitals with these
conditions about thirty billion dollars
on drug abuse treatments a year and
Americans spend about seventy billion
dollars on diets that’s an even half
trillion dollars the diets that kind of
stuff works for some people right
it works on a one-on-one basis people
who are going paleo or going gluten-free
in some sense they’re they’re kind of
trying to turn back the clock to this
world before the world we’ve created and
it works for some of them right you
certainly to get an earful if it does we
all hear about it but it doesn’t scale
right this is not a way to fix the
problem so I spent about the past twenty
years twenty years of my life
thinking about how we use data and
design to tell stories to tell stories
that could help people make better
decisions often about health and I spent
about the fast five years I did that at
Wall Street Journal any of that it wired
for about a decade and now I’ve spent
past five years working on healthcare
technologies trying to build the tools
that could help people with better
decisions and that time I’ve seen
billions of dollars invested in
healthcare right it’s a big wave but the
problem is it’s going at the wrong end
of the pipe right it’s going to where
the money is that half trillion dollars
but it’s not going to where the problem
is we have to think about what different
stories we could tell I believe we have
a different story we could tell about
our cities and our communities and our
civilization this is not a problem for
government this is really a problem for
the people in this room this is a
challenge to people in this room an
opportunity Buckminster Fuller the the
fellow behind the buckyball you you
heard about earlier but Windsor Fuller
was one of the crazy radical designers
of the 20th century and is an
inspiration to me I named my kid after
him he challenged us not just to think
bigger
he posited this question how big can we
think what is the capacity of us to
engage in the hardest problems that face
mankind face humanity and in this case I
believe we face a very big challenge
indeed I think we have to do nothing
less than to rebuild civilization
all right redesign it reengineer it so
that the default leads to health he gave
us a strategy to but brinster folder
talked a lot about how the best way to
approach problems is not to reform few
people but to reform the environments in
which we live all right that’s the way
to get things done so let’s apply some
buckminster fuller thinking and think
about these four areas of our
civilization okay our food our shelter
transportation entertainment the first
strategy that I would suggest is that
people who are creating new products who
want to design for health who must
design for health we try to make this
irresistible right we try to make the
healthy choice irresistible we want
things that don’t just make people feel
like they’re doing better but actually
are better for them right we want to
exploit the defaults we want to think
about nudge theory and other tools that
we can do to make the Healthy Choice the
easy choice and third we want to sweat
the logistics health is I always say
this health is a logistics problem not a
science problem it’s a matter of
delivering the right goods and services
and care to people at the right time
that’s the none and so to tackle this
problem we need be thinking about what
we’re creating and what we’re building
not just in three dimensions but in
force four dimensions I’ll give you
example what I mean for companies
someone I’m gonna run through some
examples of companies that I think are
doing this now first is appeal sciences
there’s this amazing company that’s
taking this problem of access to food
access to healthy food ok it’s a problem
a lot of people have talked about and
traditionally the approach is to build
more grocery stores in neighborhoods
right to increase access by building
stores what appeal Sciences is doing is
they’re taking an other approach they’re
taking a fourth dimension approach and
thinking about time they’re actually
making healthy good nutritious food last
longer so they don’t what when it does
become available to people it’s there
and on the Shelf longer in a healthy
state that’s food in entertainment our
point is to Niantic labs so an antic
labs is a company that’s behind a
company a lot of or behind a video game
a lot of you’ve heard of called Pokemon
go right this was a huge phenomenon a
couple years ago and the
lot of people thought it was just a fad
right this engaged gaming where people
get out into their neighborhoods and
start spelunking and trying to pick up
whatever they were trying to pick up
that was a huge fad but this picture
here is from this year this is still
going strong Pokemon go this was in
Santa Monica this summer and importantly
Niantic is now taking these same
principles engage gaming to a new game
that’s going to come out any day now
it’s the new Harry Potter game and that
I think is a big deal because it’s gonna
change how our children think about
video games and entertainment it’s gonna
make moving part of the proposition in
shelter I want to point to Ori systems
Ori systems is this amazing company
that’s using robotics that turn small
spaces into multifunctional spaces so
that a living room can transform into a
bedroom and back to a living room with
just the touch of a button and this is
going to change not just individuals
lives right how we are we kind of work
in our spaces that are live in our
spaces but it’s going to transform
communities because it’s going to allow
us to live in higher density
environments and have more contact with
our friends and family and in
transportation I want to point you to
lift now we’ve all heard about lift and
and you might think of them as just the
good guys in car sharing but they’ve
actually done some amazing things in
just the last few months starting in
July they started they bought a bicycle
company so now they rent bicycles right
that’s part of their service they now
have East scooters built into the system
who doesn’t have a nice scooter startups
these days but they do too and finally
they’ve done this they’ve started to
build public transportation into their
app so that I’ve taken public transit is
the best choice they want to nudge you
towards that choice and you might have
to walk a couple blocks but that may be
the most efficient way to get there this
I believe is a big deal so we need more
examples right those are some some
worthy examples but we need more
examples I want this room to be the
place where more examples emerge so I
want you to ask yourself is my company
or product or organization building for
health or is the net impact of it going
to be more illness more more passivity
I’m going to give you a checklist of
five questions
five questions you can ask yourself and
evaluate what you’re doing right and
evaluate the companies and services that
you buy by this checklist the first one
is does it reduce the time does my
product or company or service does it
reduce the amount of time that people
spend alone right is an increase a
solution or reduce it does it help
people move more does it get them
outside is it good for me and good for
my friends or family and community right
is it not just an I win and you lose
situation as so many products are here’s
a good one does my product make people
feel better after they use it and
finally do people benefit more the more
they use it right now I’ll give you a
very simple way to think about this
checklist it’s a it’s a one-stop rubric
I’m gonna call it the doughnut test okay
this is a application of one of my
favorite little principles in economics
it’s called the marginal utility curve
it’s a very simple way to measure the
value or benefit we get out of something
per unit per unit of a good or service
right so so bang for the buck so to
speak and in the case of donuts right
that first don’t on taste great right we
get a lot of pleasure out of that first
doughnut partly because we know we
shouldn’t be eating it but it gives us a
lot of pleasure
the second doughnut not so much right we
still finish it we still eat the whole
thing but it’s not as satisfying as the
first one and by the third and fourth
and fifth donut
we’re actually chipping away at any
value we get we have to think about our
companies we create the companies we use
the products we use according to the
donut test do they yield a net benefit
or a net negative so this is a concept
in an idea that I’ve been thinking about
a lot over the last years and we are now
starting to turn it into an organization
in the community we’re calling a
building H it’s something that I’m doing
with my friend Steve Downes who’s from
the Robert Wood Johnson Foundation Steve
talks about health not as a vertical
market but as a horizontal value and I
think that’s something that we all need
to think about how can we internalize
this proposition of
building health into everything we do I
want to leave you with four examples of
how we’ve done this before right this is
a big deal I know it’s silly and almost
crazy to talk about rebuilding
civilization but we can do it it is
within our means 2,000 years ago the
Romans built aqueducts across hundreds
of miles of the Roman Empire bringing
fresh water clean fresh water into their
cities 200 years ago the cities of
Europe and North America they were torn
up really remade for public sanitation
right to make sure that people had safe
environments and safe neighborhoods that
they could use in living transformed the
way we think about cities 20 years ago
transportation engineers in the United
States got religion finally about
bicycles and they started to build in
networks of bike lanes throughout our
cities now I biked in San Francisco
we’re not there yet we have a lot of
lanes to build but we’ve made a human
tremendous progress over the last 20
years and just two years ago
Google’s sidewalk labs started a pilot
project in Toronto where their Rican
sieving the whole city to be built
around the principles of sustainability
and health so that’s two thousand two
hundred twenty and two years ago today
it’s your turn today it’s our turn to
start building health into everyday life
thank you very much [Applause]
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