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Master Gardener Volunteers: Good new blog, great benefits

April 29, 2010 By 5 Comments

We were recently alerted to a new blog about all things Master Gardener, which got us thinking about the program. For those of you who don’t know, the Master Gardner Volunteer (MGV) program is an extension effort based on volunteers who promote public education in horticulture. The volunteers provide educational assistance about trees, lawns, vegetables, ornamentals and a host of other topics. Volunteers go through extensive training, pass an exam, and make a minimum time commitment to the program.

My Cornell colleague Lori Bushway has done a great job of educating me about the MGV program. And I think it’s hard to find a better example of how to harness the power of volunteering. There are over 90,000 Master Gardener Volunteers nationwide, and it’s estimated that they create an annual service value of over $100 million. The benefit to communities is huge and well-documented.

But after our visit from volunteering researcher Mark Snyder, we wondered: What about the benefits to participants? We’d expect MGV participation to be good for the volunteers, but true to our name, on this blog we obsessively look for research evidence.

Well, from the preliminary research available, it’s not just local gardeners who benefit from MGV, but also the volunteers. First, they get new knowledge. Emilie Swackhammer and Nancy Ellen Kiernan found that MGVs made clear knowledge gains over time in areas like botany, soils, plant disease, integrated pest management, and other areas. In addition, their confidence increased in their ability to answer questions from community members in these areas (here’s the article).

What about areas beyond horticultural knowledge? T.M. Waliczek and Roxanne Boyer’s article looked at more personal outcomes. They found that MGV training and participation led to increased physical activity, social activity, self-esteem, and other positive effects among Master Gardener volunteers.

Talk about a win-win situation: Volunteers work to improve their communities through promoting citizen involvement in horticulture, and along the way increase the knowledge and quality of life of the volunteers themselves. Go Master Gardener Volunteers!

Filed Under: Cornell Cooperative Extension, Evidence-Based Living, Health and Wellness Tagged With: , ,

Chocolate and depression: The study vs. the media

April 27, 2010 By 2 Comments

I’m always on the lookout for good studies that are misinterpreted by the media (see here and here for examples). Why is this important? Because those of us whose profession it is to translate research findings to the public tend to get smacked upside the head by media misrepresentations. The public gets so used to duelling research findings that they become skeptical about things we are really certain about (e.g., climate change).

If you read your newspaper or watched TV in the last week or so, you may have seen media reports on the relationship between chocolate and depression. Now I love chocolate, and I’m not ashamed to admit it. I spent a year living next to Switzerland, and I can name every brand produced in that country (and I had the extra pounds to show it).

So I got concerned when I read the headlines like this:

Chocolate May Cause Depression

Chocolate Leads to Depression?

Depressed? You Must Like Chocolate

It was a matter of minutes for us to find the original article in the Archives of Internal Medicine. (The abstract is free; unless you have access to a library, you have to pay for the article.)  It’s clearly written, sound research. And it absolutely does not say that chocolate leads to depression (whew!). Indeed, the authors acknowledge that the study can’t tell us that at all.

The research used a cross-sectional survey of 931 subjects from San Diego, California, in which they asked people about both their chocolate consumption and their depressive symptoms. By “cross-sectional” is meant a survey that takes place at one time point. This is distinguished from a longitudinal survey, where the same people are measured at two or more time-points. Why is that important here?

Here’s why. What epidemiologists call “exposure” – that is, whatever might cause the problem (in this case, chocolate) – is measured at the same point in time as the outcome (in this case, depression). For that reason, we can’t be sure whether the chocolate preceded the depression, or the depression preceded the chocolate. They both are assessed at the same time. So we can never be sure about cause and effect from this kind of study.

Now, a longitudinal study is different. The advantage of a longitudinal study is that you can detect changes over time. In this case, you could establish depression and chocolate consumption levels at Time 1, and keep measuring them as they continued over time. For example, if some people who weren’t depressed at Time 1 started eating chocolate and became depressed at a later point, we have stronger evidence of cause and effect.

As good scientists, the authors acknowledge this fact. They note that depression could stimulate cravings for chocolate as a mood-enhancer, that chocolate consumption could contribute to depression, or that a third factor (unknown at this point) could lead to both depression and chocolate consumption (my own pet theory: Valentine’s Day!).

In the interest of full disclosure, some of the media did get it right, like WebMD’s: succinct More Chocolate Means More Depression, or Vice Versa. But because some media sources jump to the most “newsworthy” (some might say sensationalist) presentation, there’s no substitute for going back to the actual source.

Finally, let me say that there is only one way to really establish cause and effect: a randomized, controlled trial. One group gets chocolate, one doesn’t, and we look over time to see who gets more depressed.

Sign me up for the chocolate group!

Filed Under: Evidence-Based Living, Health and Wellness, In The Media Tagged With: , , ,

Want better volunteers? Understand their motivation

April 23, 2010 By 1 Comment

We just had a fantastic visit today by Prof. Mark Snyder, Professor of Psychology at the University of Minnesota. Prof. Snyder is a top researcher who also has a strong interest in improving people’s lives in the “real world.” A dominating interest of his is, to put it simply, why people do good things. Why do people help others when they don’t have to, and when it even may not seem in their selfish interests to do so?

This led him to a two-decades long program of research on volunteering. Research shows that most people endorse volunteering and see it as a good thing. However, only a minority of those who hold this positive value actually volunteer. Prof. Snyder is exploring what can be done to move general motivation into actually volunteering. As part of his research, he has developed the Volunteer Functions Inventory, which identifies main motivations for volunteering.

You can find out more about his research and intervention programs here. Two points of particular interest for everyone trying to recruit volunteers:

First, volunteers stay on the job longer if their original motivation for volunteering is met. So someone who comes to an organization primarily interested in making friends could best be put in a more social situation, whereas someone coming to explore a new career could get a different set of tasks. The take-home for groups that use volunteers is this: It’s critically important to explore why volunteers want to work for the organization, and to try to match tasks to that motivation.

Second, many of the longest-term volunteers are motivated at least in part by what we might call “selfish” reasons. They want peronal growth, career experience, social contact, or other personally rewarding things. This doesn’t mean they aren’t altruistic — they are that, too. Prof. Snyder coined the term “selfish altruism” to describe this mix of motives. The implication is that it’s okay to want to benefit from the volunteer work, and organizations should feel free to market their volunteer positions that way (focusing on the potential benefits to volunteers).

So Prof. Synder’s work definitely falls in the “research you can use” category. Many of his publications are listed on his web site. He has also created a center that studies positive action, including volunteerism and civic engagement, and it’s well worth a look.

Filed Under: Cornell Cooperative Extension, Evidence-Based Living Tagged With: ,

Building extension’s public value: We can be more convincing

April 22, 2010 By 3 Comments

Those of us who work in the Cooperative Extension system tend to love it. Over the past weeks, I’ve been involved in an interview project with older people who have been involved in extension most of their lives, either as volunteers or as paid employees. Their devotion to extension’s mission shines through every interview. From the inside, the value of what we do seems self-evident.

Then we come up against the harsh reality: Extension is heavily dependent on public funding. Many other constituencies, and in particular elected officials and the general public, need to see the value of what we do. How can we convince those who hold the purse-strings that the work of extension has public value, worth spending government funds on?

I recently came across the work of Laura Kalambokidis, a faculty member in the Department of Applied Economics at the University of Minnesota. One of the pleasures of writing a blog is that you start reading other people’s, and Laura’s brings a fascinating perspective to extension.

In an article in the Journal of Extension, Laura raises the issue of identifying the public value of extension. She lays out the problem facing us succinctly:

The current economic climate has placed significant pressure on the budgets of state and county governments. In turn, those governments have compelled state Cooperative Extension Services to defend their continued receipt of state and county funding. Even when policymakers are persuaded of the efficacy of an Extension program, they have questioned whether the program should be supported with scarce public dollars rather than through user charges.

To address this issue, Laura translates economic theory and research from public sector economics to practical issues of extension. What policymakers need to be convinced of is that extension work has public value – that is, why should the public pay for our services rather than being purchased on the private market? The challenge is to show that extension activities are a public good, one that benefits society as a whole (in addition to benefitting specific program participants). In her words: “Extension staff must also be able to explain why citizens and policymakers who are not direct program participants should value the program.”

In the extension programs I’ve created, I confess that I haven’t done this. When I justify my programs, I point to the good outcomes and satisfaction for program participants. But I don’t really look at the public good – how they have benefits  for the larger community, beyond my participants. For example, I’ve created extension programs to train nursing home staff. But someone could ask: “That’s well and good, but why shouldn’t those programs be paid for by nursing homes as a private good? What’s the public value for what you do?”

Laura’s work suggests that the most effective case can be made for public value when there is market failure – we provide something that isn’t effectively offered privately – and when there are issues of fairness and justice not addressed by private markets. Her article gives a detailed process for identifying public value.

To give one example, extension folks typically believe that they address market failure by providing information. But Laura suggests we consider this carefully, asking questions like:

  • Is there a demonstrable information gap?
  • Can you show that other entities are providing wrong or incomplete information to consumers?
  • Does your information direct consumers (and producers) toward activities that have external benefits?
  • Are you providing information to a population that does not have access to private information sources?

Laura has developed a workshop program where she helps extension associations determine public value of their programs and how to present them as such. More information is available on her web site, which includes a blog.

Filed Under: Cornell Cooperative Extension, Evidence-Based Living, policy Tagged With: , , ,

Children and Earth Day

April 20, 2010 By 1 Comment

Earth Day is just around the corner and, as it does every year, it’s got me thinking about my relationship to the planet. When I was a kid growing up in rural Kentucky, some of my best memories are of the hikes my friends and I used to take through the woods and up to the top of the hill behind our house to have picnics.  It was a pre-tech world (before computers, cell phones, and Ipods) when kids created their own recreation. Our family vacations often consisted of camping trips to state parks with my grandparents, where we’d sleep in tents and I’d spend the days fishing alongside my grandmother. These experiences gave me a deep appreciation for nature. Are they related to my motivation to do what I can to improve the environment? What does research tell us about this topic?

Nancy Wells, an environmental psychologist in the Design and Environmental Analysis Department of the College of Human Ecology, has researched childhood exposure to nature and adult attitudes toward the environment. In her article Nature and the Life Course: Pathways from Childhood Nature Experiences to Adult Environmentalism, she examined the question of what specific activities or events in a child’s life might set them on a path toward later-life commitment to environmental attitudes and behaviors. Wells and her colleague, Kristi Lekies, examined interviews of 2000 adults living in urban environments who were questioned about their childhood exposure to nature. Results from the analysis of their responses provide insight into the origins of commitment to pro-environmental values.

Wells and Lekies found that exposure to “wild” nature (hiking, playing in the woods, hunting, fishing, etc.) and “domesticated” nature (picking flowers, gardening, etc.) both have a positive relationship to adult environmental attitudes. In addition, they found that “wild nature” participation was positively associated with environmental behaviors, while “domesticated nature” participation was marginally related to environmental behaviors.

So, the take away message is that it’s important to encourage children in every way we can to spend time outside in nature.  This is one very concrete thing each of us can do to contribute to the development of healthy children who feel connected to the environment, and, in turn, work to improve it later on in their lives.  I’ll always be grateful to my parents and grandparents for giving me this enduring gift. And now, as an adult, I wouldn’t trade it for anything.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , ,

Teen Sex and Pregnancy: Evidence from Systematic Reviews

April 20, 2010 By 2 Comments

Having just posted on systematic reviews, let’s take a look at some recent examples on a topic of importance in contemporary society: sexual activity and pregnancy on the part of teenagers. We tend to throw up our hands about this problem, but systematic evidence-based reviews show that some intervention programs actually work, and others don’t. Take a look at these as examples of how systematic reviews work and what they can tell us.

A Cochrane Collaboration review team examined the literature on teen pregnancy prevention. They examined studies of primary pregnancy prevention carried out in a variety of settings. Findings from a total of 41 randomized, controlled trials were synthesized. The review team found that programs that combined educational and contraceptive interventions were effective in preventing teen pregnancy.

A systematic review was conducted of programs to promote condom use among teens. This study is a good example of a review that concluded there was insufficient evidence to be definitive. Although many individual intervention studies showed modest effects, the authors noted that the quality of most of the studies was poor. So in this case, we really can’t be sure interventions to promote condom use really work.

What about abstinence? Our friendly neighborhood Cochrane reviewers have taken this on, too. They conducted a systematic review of abstinence-only HIV prevention programs, and found no evidence that such programs protected against sexually transmitted diseases. They also did not prevent teens from engaging in unprotected intercourse, the frequency of intercourse, the number of sexual partners, age of sexual initiation, or condom use.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , , , ,

Evidence-based systematic reviews: As close to certainty as it gets

April 20, 2010 By 9 Comments

Sometimes when I give talks, I like to use this catchphrase: For almost all of human history, our major problem was a lack of information, but over the past half century the problem has become an overabundance of information. Not only can you access multiple opinions on any topic, but the scientific evidence can seem to be all over the place. For any social or health problem humans experience, there are typically hundreds of studies. Making things worse, the studies can seem to contradict one another.

So people have come up with a solution. Rather than simply summarizing research findings in narrative form (remember what you used to do for a high school or college term paper?), researchers conduct systematic evidence-based reviews, in which they use sophisticated methods to bring together and evaluate the dozens, hundreds, or even thousands of articles on a topic. (There’s a good summary of the methods for systematic reviews on the Bandolier site.

When thinking about evidence-based reviews, you have to decide whether you agree with one basic proposition. This proposition holds that the findings of sound scientific research studies provide more credible evidence about solving human problems than personal opinion, anecdotes, or “gut feelings.”  Not everyone believes this (or at least not all the time). For those who do agree (as we do at Evidence-Based Living), then what is required is a systematic review of the research evidence, leading to guidelines for program development and their use in actual programs with audiences we serve.

The authors of a systematic review will tell you exactly what methods they used to identify articles for the review, how the articles were critically assessed, and how the results were synthesized across studies. Then the systematic review itself is peer-reviewed at a scientific journal, providing even more scrutiny of its findings. In some cases, the authors will use highly technical mathematical methods to synthesize the findings of studies, producing what is called a meta-analysis.

A systematic review has many benefits over the kind of review that simply summarizes a bunch of studies. You’ve seen this kind of review, which usually runs something like: “Smith and Wesson found this finding, but see Abbot and Costello for a different finding” or “Although most research shows this finding, there are a number of studies that fail to support it.” The systematic review looks at why the studies differ, and can exclude those studies that have inadequate samples or methods. And by looking at many studies, it allows us to make general conclusions, even though participants and study settings might be different.

Let’s take one example of how a systematic review is different from other reviews. If you read statements by groups advocating one perspective, they usually cite just the research articles that support their position. The hallmark of a systematic review, on the other hand, is a search for all articles on a topic. They go to great lengths to find every study done, so all can be evaluated. For this reason, systematic reviews are usually done by teams, since it’s rare that an individual has the time to find all the available research. By looking at all studies, a systematic review can come to conclusions like: “All studies using method X found this result, but studies using method Y did not.”

Systematic reviews can be disappointing, because they often come up with the conclusion that the research isn’t sufficient to come to a conclusion. But that in itself can be useful, especially if there’s one published study that has gotten a lot of attention in the media, but isn’t supported by other research.

The best library of systematic reviews has been described in a previous post: The Cochrane Collaboration.” But there are plenty of systematic reviews published each year from other sources. An example is in our post on antidepressants. If you want the most definitive evidence available as to whether a program or practice works, look to systematic reviews.

Filed Under: Evidence-Based Living, The Learning Center Tagged With: , , ,

Relax! Evidence-based stress reduction

April 18, 2010 By 3 Comments

Many so-called “alternative” health practices are alternative for a very good reason: There is little or no scientific evidence to back them up. Indeed, some very popular treatments have no scientific basis – homeopathy is a good example, where scientific review after scientific review comes to the conclusion that no homeopathic remedy is better than a placebo (for good examples of reviews see here and here).

Therefore, it’s great to come across a health practice that some might see as being out of the mainstream, but which has a very sound basis in the evidence. I was reminded of this when I heard a radio interview with Dr. Jon Kabat Zin. Kabat-Zin’s career has been devoted to the study of mindfulness-based stress reduction (MBSR).

A nice overview is provided in an except from the radio program (it relaxed me just listening to it). MBSR uses meditation, breathing techniques, and other methods to help promote a state of “mindfulness,” a way of learning to pay attention to what is happening in life that allows a greater sense of connection between mind and body. Mindfulness meditation forms a core of the training, and the evidence of the effectiveness this type of meditation to reduce stress has continued to accumulate over the past decade.

Whereas many alternative practitioners and supplement-makers avoid subjecting their products to rigorous research methods,  Kabat-Zinn and colleagues have embraced scientific testing, including randomized-controlled clinical trials. They have been careful to reproduce the results in multiple studies, showing the effects of mindfulness meditation on such conditions as chronic pain and anxiety, and even to speed recovery from illness. (Always remember to be suspicious when a so-called health practice lacks this kind of evidence.)

Information is available at their program’s web site, which is based at the University of Massachusetts Medical Center (not a bad place to be if you are interested in evidence-based health care approaches). There is interesting information about mindfulness meditation as well as a review of the extensive research base.

So although it’s a busy time of year: Relax! And take a look at one evidence-based approach to help you do so.

Filed Under: Evidence-Based Living, Health and Wellness Tagged With: ,

Why do you think kids make risky decisions? Bet you’re wrong…

April 11, 2010 By 5 Comments

On a trip to Dallas last week, I stayed in a large hotel that was playing host to a convention of high school student members of a service organization. A group of boys was roughhousing on a balcony where only a low railing served as a barrier against a 3-floor drop to the lobby, and it looked like a shove in the wrong direction would send someone over the edge. Down swept a small phalanx of chaperones exclaiming what a bunch of idiots the kids were. The young fellows sauntered off, muttering about “over-reacting,” and “always ruining it when we’re having fun.”

To adults, the reason for this behavior seems obvious: Kids are illogical and don’t understand the risks of their behavior. We assume that they do risky things – like use drugs, drive drunk, or have unprotected sex – because they are irrational beings. Like my grandmother would say: “Those kids just don’t have any sense.”

Enter Cornell professor Valerie Reyna to show us that we’re wrong about this, and our misconceptions have implications for how we try to help kids make less risky decisions. A faculty member in Human Development, Prof. Reyna conducts groundbreaking work on judgment and decision making. And she has taken the additional step of turning her basic research into practical programs to help young people.

In the laboratory under controlled conditions, she has conducted many studies of children and adolescents. Following a translational research model, she and her colleagues wanted to first understand the causal mechanisms that generated risky behavior. What she learned in the lab about the psychology of adolescent risk-taking and about how risky decision making changes with age, she found could then be used to modify unhealthy behavior.

The findings are fascinating. It turns out that adolescents don’t take risks because they are irrational and feel invulnerable and immortal. In fact, it’s because they are too logical. Adults can access informed intuition to avoid risk, whereas adolescents count up and weigh risks versus immediate benefits, and often the risk comes out on top. As Prof. Reyna puts it, “We found that teenagers quite rationally weigh benefits and risks. But when they do that, the equation delivers the message to go ahead and do that, because to the teen the benefits outweigh the risks.”

Existing prevention curricula that had been developed tended to have effects that faded over time and were not as large as they could be.  Prof. Reyna translated her research findings into a curriculum based on both theory and empirical findings.  She has created interventions to teach adolescents to think categorically—to make sweeping, automatic gist-based decisions about life: “unprotected sex bad,” “illegal drugs bad.”

After more than 800 teenagers participated in a randomized controlled trial, the investigators found that the curriculum was more broadly effective, and its effects lasted in many cases for long periods of time.

Prof. Reyna’s web page Resources on Risky Decision-Making in Adolescence is a terrific resource. I recommend starting by watching one of her presentations on the topic, conveniently available on the site. An article in the New York Times provides a quick overview. If you are a professional working with adolescents (or if you have one in your family) you’ll find a whole new way of looking at why kids take risks.

Filed Under: Evidence-Based Living, Health and Wellness, policy, Youth Development Tagged With: , , , ,

How does the physical environment affect child well-being?

April 8, 2010 By 5 Comments

Gary Evans, a Cornell researcher in the Department of Design and Environmental Analysis, has spent much of his career researching this important issue.  Evans, who is an environmental psychologist, has completed a large body of research that examines the relationship of crowding, noise, housing and neighborhood quality on the lives of children.  His research reveals that these factors can have a lot of impact on a child’s academic achievement, as well as cognitive and social development.

Noise is one of the factors that Evans has studied.  Music, conversation and transportation are the most common noises that children are exposed to.  Evans and colleagues have found that noise levels, such as those in homes near airports, can result in children’s reading delays. Children often adapt to exposure to chronic noise by tuning out auditory input, which can also result in delayed language development.

Overcrowding is another factor that can result in biological and cognitive delays for children.  While family size is not a factor in overcrowding, Evans has identified density (the number of people in a room) as a crucial variable to measure when examining the effects of crowding. Children may withdraw as a way of coping with over stimulating environments. Specific effects of crowding on preschoolers are distraction and less constructive play. 

Research has also found that neighborhood environments can have a great impact on child well-being.  Some of the factors that have the most impact are housing quality, toxic exposure, access to natural settings, transportation and health services. Natural settings have a constructive effect by providing children with the opportunities to develop gross mother skills and alleviating the negative effects of children’s exposure to chronic stress.

The good news is that there are many things that can be done to improve the environments children are living in and address negative environmental factors.  These ideas are detailed in a brief that you can read entitled The Effects of the Physical Environment on Children’s Development.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: ,

Evidence-based practice with children and adolescents: A great resource

April 5, 2010 By Leave a Comment

Let’s say you have a long lunch hour (hey, it’s spring, so why not take, say, 90 minutes?). You could put that time to good use reading an excellent publication on evidence-based practice and what it means for kids. This was published a little over a year ago, but only recently came to my attention. I’m sorry I didn’t see it sooner, because it helps answer a lot of questions about what “evidence-based” really means –  whether or not you happen to be interested in children.

It’s the American Psychological Association’s Disseminating Evidence-Based Practice for Children & Adolescents, available here.

The report begins with a wake-up call:

The prevalence of children’s behavioral disorders is well documented, with 10 to 20% of youth (about 15 million children) in the United States meeting diagnostic criteria for a mental health disorder. Many more are at risk for escalating problems with long-term individual, family, community, and societal implications.

 It then moves to a nice summary of the varying contexts in which children’s problems arise and the systems for dealing with them. It also uses an inclusive definition of Evidence-Based Practice (EBP). They look at EBP as way of moving tested practices into real-world settings. However, they also emphasize the importance of integrating these approaches with practice expertise. Evidence-based interventions for children and youth are critically important so that practitoners can draw on programs that have “track records” – that is there is longitudinal data for short-term and long-term outcomes, showing that the program reduces problems or symptoms.

The report highlights four “guiding principles” for evidence-based approaches with children and youth:

 1. Children and adolescents should receive the best available care based on scientific knowledge and integrated with clinical expertise in the context of patient characteristics, culture, and preferences. Quality care should be provided as consistently as possible with children and their caregivers and families across clinicians and settings.

2. Care systems should demonstrate responsiveness to youth and their families through prevention, early intervention, treatment, and continuity of care.

3. Equal access to effective care should cut across age, gender, sexual orientation, and disability, inclusive of all racial, ethnic, and cultural groups.

4. Effectively implemented EBP requires a contextual base, collaborative foundation, and creative partnership among families, practitioners, and researchers.

All points worth thinking about!

If you don’t have time for the entire report, some interesting sections are: a review of the history of the “evidence-based” concept (for all of us who wonder where this came from all of a sudden), a good discussion of definitions, and a review of what the evidence shows about prevention programs.

 Happy reading!

Filed Under: Evidence-Based Living, The Learning Center, Youth Development Tagged With: , ,

Agricultural Extension: The Model for Health Reform?

April 4, 2010 By 1 Comment

Atul Gawande is a rare mix: A practicing surgeon who is also a wonderful writer. In thinking about our health care crisis and reform, he started looking for models in American history that have worked to transform systems. In a recent article in the New Yorker entitled “Testing, Testing,” he found his model in a surprising place: Agricultural Extension. His treatment of early success of the extension system makes for fascinating reading (and for those of us working in the system, a nice pat on the back!).

Gawande notes that our health care system lags behind other countries but costs an astronomical amount. He asks: What have we gained by paying more than twice as much for medical care as we did a decade ago? Not much, because the system is fragmented and disorganized. To control costs, the new health reform bill proposes to address many problems through pilot programs: basically, a number of small-scale experiments.

Lest this approach seem absurdly inadequate, Gawande shows that it has worked before – in agriculture. He takes us back to the beginning of the 20th century, when agriculture looked a lot like the current health care system. About 40% of a family’s income was spent on food. Farming tied up half the U. S. workforce. To become an industrial power, policymakers realized that food costs had to be reduced so consumer spending could move to other economic sectors. And more of the workforce needed to move to other industries to build economic growth.

As Gawande sums it up,

The inefficiency of farms meant low crop yields, high prices, limited choice, and uneven quality. The agricultural system was fragmented and disorganized, and ignored evidence showing how things could be done better. Shallow plowing, no crop rotation, inadequate seedbeds, and other habits sustained by lore and tradition resulted in poor production and soil exhaustion. And lack of coordination led to local shortages of many crops and overproduction of others.

Unlike other countries, the U. S. didn’t pursue a top-down, national solution. But government didn’t stay uninvolved either. Gawande tells the intriguing story of Seaman Knapp, the original agricultural extension pioneer. Sent by USDA to Texas as an “agricultural explorer,” he persuaded farmers one-by-one to try scientific methods, using a set of simple innovations (e.g., deeper plowing, application of fertilizer). As other farmers saw the successes (and in particular, that the farmers using extension principles made more money), they bought into the new practices.

Extension agents began to set up demonstration farms in other states, and the program was off and running. In 1914, Congress passed the Smith-Lever Act, which established the Cooperative Extension Service. By 1930 there were more than 750,000 demonstration farms.

The rest is, as they say, history. Agricultural experiment stations were set up in every state that piloted new methods and disseminated them. Data were provided to farmers so they could make better informed planning decisions.

And it worked. Gawande sums up:

What seemed like a hodgepodge eventually cohered into a whole. The government never took over agriculture, but the government didn’t leave it alone, either. It shaped a feedback loop of experiment and learning and encouragement for farmers across the country. The results were beyond what anyone could have imagined.

Gawande profiles Athens, Ohio agricultural extension educator Rory Lewandowski, showing that the system performs the same vital functions it did a hundred years ago. Gawande suggests that the health care system can’t be fixed by one piece of legislation. It will take efforts at the local level that involve “sidestepping the ideological battles, encouraging local change, and following the results.” Impossible, people say? Not really, since it’s been done before – in agricultural extension.

Filed Under: Evidence-Based Living, Health and Wellness, policy Tagged With: , , , ,
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