Quand l’Etat contrôle nos assiettes

Published on 12 May 2012 in International and Recherche. 0 Comments Tags: , , , , .

(Translation in progress...)

En début de semaine, l’équipe de Daniel Taber du Centre des politiques de santé de l’université de l’Illinois à Chicago a publié dans les Archives of Pediatrics & Adoslescent Medicine un article (abstract en anglais seul accessible gratuitement) tentant d’évaluer la législation californienne en matière de lutte contre l’obésité visant à interdire la vente de junk food dans les établissements d’enseignement secondaire. Ils ont comparé les habitus alimentaires des élèves californiens à ceux de 14 Etats des USA qui n’ont pas mis en place une telle législation.

Le débat fait rage dans les milieux de la santé publique, et l’on se souvient des divergences de la directrice adjointe de l’OMS, Catherine Le Gales, économiste française, avec sa nouvelle directrice générale, la Chinoise de Hong Kong, de culture néo-libérale, Margaret Chan. Notre économiste était favorable à davantage d’intervention de l’Etat pour la prévention et la lutte contre l’obésité, et donc davantage de réglementation visant à limiter l’accès aux produits gras, salés, et sucrés notamment en milieu scolaire. Margaret Chan défend des positions privilégiant la responsabilité individuelle et la liberté de choix, éventuellement par une éducation sanitaire renforcée pour permettre des choix personnels éclairés.

La Californie, a tranché en juillet 2007 en imposant une législation contraignant les établissements scolaires à ne pas autoriser dans leur enceinte la vente de nourriture en dehors des cantines (ex. boutiques, stands tenus pas les élèves, ou distributeurs automatiques). Il ne s’agit pas d’une interdiction totale de vente, mais de limitations très précises : produits mis à la vente de moins de 400 calories dont un maximum de 100 calories d’origine lipidique, et moins de 10% de graisses insaturées, avec des limites à 35% de sucres.

L’équipe de Taber et coll. a cherché à mesurer l’impact de cette législation sur les consommations alimentaires des adolescents californiens en comparant les réponses à un questionnaire portant sur l’alimentation des 24 dernières heures de 114 élèves du secondaire en Californie et 566 élèves provenant de 14 Etats n’ayant pas mis en place de telles législations. Les résultats sont clairs : les élèves californiens mangeaient en moyenne 158 calories de moins par jour que les élèves des autres Etats ; leurs consommations alimentaires en dehors de l’école était similaire à celles des élèves des autres Etats. En restreignant l’analyse sur les élèves d’origine hispanique (dont les taux d’obésité sont particulièrement élevés aux USA), les chercheurs ont retrouvé des résultats similaires.

Bien sûr, les chercheurs soulignent que le niveau de preuve apporté par ce type d’étude ne garantit pas avec certitude l’inférence causale entre la mise en place de la législation de 2007 et la modération de consommation alimentaire des élèves californiens. Mais ce type de recherche permet de renforcer la position de ceux qui soutiennent que des réglementations un peu contraignantes en matière d’alimentation peuvent se montrer efficaces dans la réduction de la prise de poids chez les jeunes. D. Taber, dans une interview du Los Angeles Times en date du 8 mai (accessible en anglais), présente la législation californienne comme un début encourageant, mais encore insuffisant “les écoles de Californie ont su tenir à l’écart la vente d’aliments mauvais pour la santé des jeunes, mais ils n’ont pas encore prouvé qu’ils avaient su les remplacer par des aliments bons pour leur santé“, en ajoutant : “ce n’est pas parce que les élèves ne mangent plus de barres chocolatées qu’ils se sont mis nécessairement à consommer des salades et des épinards à la place“.

En revanche, les faits commencent à objectiver qu’un peu plus d’Etat dans l’assiette est peut être nécessaire, si l’on veut véritablement prendre à bras le corps et s’attaquer avec efficacité au problème du surpoids et de l’obésité chez les jeunes, dont l’épidémie s’étend et s’intensifie partout dans le monde depuis quelques décennies.

Digital revolution in higher education

Published on 6 May 2012 in International and Offre de formation. 0 Comments Tags: , , .

On 3 May, the New York Times published an article by David Brooks, (in English, free online) entitled The Campus Tsunami. It might be thought that online education is not new. People have been talking about it for a long time – perhaps not since 1989 like the University of Phoenix in Arizona – but France does not have the equivalent of 4 million American students taking degrees who took at least one online class (2007 data). However, most French universities and grandes écoles are also moving towards e-learning.

It is worth spending a little time to find out what is happening in higher education in North America. Last week (video in English), Harvard University and the Massachussetts Institute of Technology (MIT) set up a $60M joint venture to provide free online university education. On 12 April, two professors at Standford University, Andrew Ng and Daphne Koller, have formed a company, Coursera, which offers interactive courses in the humanities, social sciences, mathematics and engineering. You will find free access (after free registration online) to a remarkable course on vaccines, one on basic statistics, an introduction to genomics, a course on health policies in relation to the Obama reform (Affordable Care Act), to give just a few examples close to this blog’s centre of interest. With a risk capital of $16M, the Coursera start-up has set up a partnership with Stanford University and has also signed up the University of Pennsylvania, University of Michigan and Princeton University as partners. The largest North American academic institutions are now considering their future on Internet. Some of them even foresee that the movement that is taking place in higher education will be comparable to that experienced by the newspaper and magazine business media for the past few years (throughout the world): a rescrambling around the Web. The President of Stanford University, John Hennessy, who was the first to describe this imminent development as a “tsunami” (in an article published in English free online in the New Yorker on 30 April, page 8).

Some people may say, “No, not at university, that’s impossible.” Or will fast online browsing replace deep reading? Will computational thinking oust philosophical reasoning?

Others will comment that it is also a form of democratisation and accessibility to elite universities. In his editorial in the New York Times, David Brooks declares enthusiastically: “Already, hundreds of thousands of students have taken accounting classes from Norman Nemrow of Brigham Young University, robotics classes from Sebastien Thrun of Stanford (udacity) and physics from Walter Lewin of MIT.” It is true that some star professors will be lecturing to millions. But what will happen to the rest of the faculty?

Will academic standards be as rigorous? How is it possible to be sure that skills have been acquired? When can face-to-face teaching be replaced by online classes? When is this impossible (or more problematic)? Will all students have the motivation required to follow online classes?

It appears – even though it is still in its infancy – that research into online learning suggests that it is roughly as effective as classroom learning. It is easier to tailor a learning experience to an individual student’s pace and preferences. Online learning seems especially useful in language and remedial education, for example. There are different phases of learning: absorbing information, reflecting upon information as you reread it and think about it, scrambling information as you test it in discussion or try to mesh it with contradictory information, and finally there is synthesis. According to David Brooks, online education mostly helps students in the first stage of learning. This allows standard teaching methods to concentrate on the other more reflective, critical stages of learning: “colleges have to think hard about how they are going to take communication, which comes over the Web, and turn it into learning, which is a complex social and emotional process.”

In the university world of tomorrow which is taking shape, a local professor will be able to help his students to compare his theses and theories with those of other authors, available online, bringing different points of view from different places in the world. The professor of tomorrow would probably do more tutoring and conversing and less lecturing than at present.

Will French higher education and research be taking up these challenges? First of all take up the issue of French-speaking? Attract the best students in the world drawn from the English-speaking public, future ambassadors of collaboration with our establishments in their own countries? Investment by North American universities in online learning is massive, how much will our European universities invest? These are the main strategic and political issues for higher education in the future.

What sort of manager are you?

Published on 29 April 2012 in International and Recherche. 0 Comments Tags: , , , , .

Most companies do not have enough managers with analytic skills (quantitative). If you are a manager and you want to assess your analytic skills (and find out how to strengthen them), read the article by S. Shah et al., researchers and managers of Corporate Executive Board (a private research and management consultancy based in Virginia, near Washington DC) in the April 2012 issue of the Harvard Business Review (article free on line, in English). In this post, I should like to give a slightly different version of the 5 item questionnaire proposed by the authors. For an executive training course intended for the managers (doctors) of the hospitals in Ho Chi Minh City (Vietnam) organised by the EHESP together with the Pham Ngoc Thach Medical University, I myself adapted the questionnaire published in the HBR for the managers of Vietnamese hospitals. This revised version is entirely my responsibility and, furthermore, it has not (as yet) been approved. I am suggesting that you answer the following questions.

1.The authorities ask you to develop a proposal to launch a new activity in the hospital. You:

a. Dig up data to generate some ideas, talk with your colleagues and then write the proposal

b. Burn the midnight oil drafting the proposal, add some supporting charts and submit the document as quickly as possible

c. Find the last proposal for a new activity in the hospital, take a look at recent data and model the new proposal on the old one

2. Reviewing recent activity statistics for your hospital you notice a spike in the activity of one of the services. You:

a. Look up some data, run some numbers and make a couple of calls to figure out why there has been an increase in activity

b. Are suspicious about the increase

c. Congratulate the head of the service on his dynamism

3. You’re leading the search for a new practitioner and must develop guidelines for evaluating candidates. You:

a. Get the CVs of several of the best practitioners recently taken on in your hospital to help you to define the ideal profile for the candidate you are looking for

b. Talk to several people you think might be suitable and interested in the job and try to understand what their profiles would look like

c. Use the criteria previously used to fill similar positions

4. You’re evaluating options for reorganising one of the activities in your hospital and your market research is inconclusive. You:

a. Choose the option you think your head of service in charge of this reorganisation would be most likely to make work

b. Rely on your intuition and your knowledge of the business and the changes expected

c. Commission more market research (market surveys, epidemiological surveys, etc) before making a decision

5. The authorities ask you to prepare the hospital budget for the coming year. You:

a. Review recent hospital budget trends and meet with your management committee to learn whether forecasts need to be adjusted for changing conditions

b. Ask your management committee to provide their budget expectations and aggregate the results

c. Project the budget on the basis of an analysis of historical trends

If most of your answers are:

As you are an informed sceptic

Bs you are a visceral decision-maker

Cs you are an unquestioning empirist

In a survey of 5,000 employees in 22 global companies (all fields of activity), 38% of the employees and 50% of senior managers were informed sceptics, the category that the authors consider to be the best equipped to make good decisions, and functions whose employees had the highest average scores performed about 24% better than other functions across a wide range of metrics (in terms of productivity, effectiveness, employee engagement, etc).

Most of the managers of the hospitals in Ho Chi Minh City proved to be informed sceptics. They all have a firm medical (clinical) or surgical experience. It is certainly not necessary to be a doctor or surgeon to be a manager, in particular a hospital manager, as can be seen from the French system. But at the EHESP we maintain that the medical culture is a good basis for management practices. Taking medical decisions is strongly influenced by empiricism, in particular by the Evidence Based Medicine approach. Management training, not only in the health field, would gain from an empiricist approach that placed the emphasis on questioning and scepticism but not from one that applied a dogma of unquestioning empiricism.