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September 22, 2022
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Allen Weiss
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The Fleeting Attention Cycle — Focus Matters for Individuals and Society

Crisis Du Jour

What are the similarities and differences among daily eating habits, dental hygiene, AIDS, Monkey Pox, childhood obesity, homelessness, food deserts, climate change, Hurricane Katrina, 9/11, and corporate scandals as well as other personal health challenges, man-made disasters, and natural catastrophes?

The above selected “cases” and examples vary from personal to societal, and geographically, citywide to regional/statewide to national. The human and financial loss also differs by severity, with no injuries or economic impact to some human harm or a few deaths, to tragically significant loss of life or extensive financial harm. The intentionality of each ranges from carelessness to random accidents to acts of nature to malicious intent. [1] Many of these disruptions are transient while others last for years.

What is similar among all of them, both personal and societal, is the “issue-attention cycle.” Anthony Downs’ 1972 foundational paper defines the observation.

“The American public rarely remains sharply focused upon any one domestic issue for very long — even if it involves a continuing problem of crucial importance to society.

Each of the problems enumerated above leaps into the public or personal domain, remains for a time, stays unsolved or self-resolves, and then fades away. Unfortunately, the same problems reoccur because the conditions that gave birth to the earlier incident remain essentially unchanged. [2]

Dynamics of the “Issue-Attention Cycle”

Health-wise and medically, we parallel the same short attention span. At first, we focus on a problem, then the condition becomes the new normal and our attention moves to the next distraction. Individuals overlook symptoms or signs until catastrophe strikes.

How often has a friend or family member ignored a significant change in weight only to evolve from being overweight to obese to morbidly obese? In fact, in the aggregate our nation is on this runway with the subsequent creation of the higher rates of diabetes, heart disease, high blood pressure, stroke, and cancer. We focus for a while then accept the condition as the new normal. Similarly, how many folks ignore a ten-pound, unintentional weight loss along with a new persistent pain only to sadly discover an occult tumor? Ignoring a new skin finding can have the same result. The delayed diagnosis makes all the difference in prognosis and outcome.

Media interaction and the resulting public attention are intimately intertwined. Preexisting stresses and problems suddenly become crises when precipitating events occur. Examples include: terrorists motivated and planning for years finally strike with tragic vengeance; conditions coalesce for winds to spin over warmer than usual oceans, thus becoming hurricanes; administrative mix-ups and dishonesty culminate in scandals; healthcare lapses continue overlooked until epidemics emerge or personal problems overwhelm.

Each stress flows through five stages of the attention cycle. 

1. Pre-Crisis Stage

Conditions exist for a worsening or a crisis, but no one is interested or most everyone is distracted by the tyranny of the present. Past and more recent examples are plentiful.

One’s weight starts to rise in mid-life and at first is addressed with diet and exercise. Subsequently, focus changes and the response is to purchase new larger sizes of clothes and punch new holes on belts to accommodate expansion. Public health officials have watched the body mass index of children and adults increase for decades, while the food industry packed calories into foods designed to be addictive by optimizing salt, sugar, and fat content as noted by Michael Moss in Salt Sugar Fat: How the Food Giants Hooked Us. [3] The potato chip ad, “Bet you can’t eat just one,” is an unfortunate reality.

Examples of lack of preparation, or at least lack of acknowledgment of a condition, create a fertile environment for future problems. Severe flooding and intense fires frequently rage in areas not previously threatened. Governments pushed updates to end-of-life, water-treatment plants down the road, and let forests grow too close to developed neighborhoods. The New Orleans government and public were completely aware of the low elevation of the city compared to Lake Pontchartrain.

2. Alarmed Discovery and Euphoric Enthusiasm

As the result of some dramatic public event, the media grabs hold and an echo chamber of stories abound. Or a warning is issued to an individual about a looming problem. Personal and societal examples abound. A common individual experience, witnessed frequently by dental hygienists , is a stern warning results in excellent compliance — for a time. But travel plans and a tight schedule erode the new, not-completely-assimilated patient behavior. Subsequently, old habits take over, resulting in poor performance even though guilt and plaque grow.

A precipitating societal event triggers public attention with intense media coverage. This alarm, through euphoric enthusiasm, invariably catalyzes society’s will to “solve this problem” instantly. A quick-fix approach ignores the underlying, long-standing, preexisting conditions — either environmental or societal — with a return to baseline and persistent jeopardy.

Multigenerational learned helplessness, defined as a sense of powerlessness, trudges on until an incident, usually a tragedy, sparks a forceful response. Subsequently, elected officials and other leaders scramble to create a solution. Optimism abounds as the underlying problem is at first recognized and subsequently examined, but ultimately the problem remains unsolved. When the time comes to invest significant resources, society’s attention slips to the next shiny new object or crisis.

3. Realizing the Cost of Significant Progress

Once one is obese from excess consumption and has diabetes or compromised breathing from smoking for decades, reversing the disease is difficult but not impossible. Eating habits can change, blood sugars can be controlled, smoking cessation has a modest success rate, breathing exercises work. But getting folks to embrace and sustain change is always challenging. Changing habits is expensive in terms of the necessary willpower and resilience.

The realization that the underlying causes of the precipitating event have deep roots and require extensive resources to dig up, starts the cooling process. In the case of personal habits and altruists trying to address societal challenges, recognition of the complex task drains the optimism from individuals. For example, many people and organizations have recognized the need to cure hunger and homelessness, but even known, effective, solutions wait for implementation.

Selfless and well-intentioned people typically lack proven effective strategies and longitudinal outcome metrics when addressing large community problems. However, these folks feel good about trying and remain self-congratulatory about their processes and involvement. All the while, underlying conditions remain unchanged, creating a fertile ground for recurrence.

Frequently, another distracting event draws the public’s interest, thus refocusing an already short attention span. As an example, American’s recent swift decline in life expectancy, attributed in part to COVID, distracts from the preexisting baseline of lower life expectancy compared to other developed nations. Climate change has exacerbated flooding, droughts, fires, and famine; global political discord has worsened economic conditions for millions, while concentrating wealth among a few. Without a fundamental reordering of these underlying society or world stresses, most of the inciting events will reoccur.

The very acts needed to reorder areas of our society or economy will create new stress by making some previously advantaged groups vulnerable. Caste, the Nature of Our Discontents by Isabel Wilkerson addresses in detail three painful, historical societal changes — segregation in the south, the Holocaust, and dismantling of the caste system in India. Fortunately American society over the past century, Germany post-WWII, and India’s government made progress, but it took an inordinate amount of time and extracted a tremendous cost. Residual inequities persist, stimulating additional attention cycles of discovery but not lasting change. [4]

4. Gradual Decline of Intense Public Interest

Resilience and persistence are probably more linked to success than talent and intelligence. Certainly, when addressing an underlying chronic illness, persistent attention matters most. Interestingly, the prognosis of a child afflicted with juvenile rheumatoid arthritis relates to the diligence of her/his mother. Other typical biological parameters are less important. Mom’s being “on the case” can avoid long-term disability.

Once the media hype transforms to the next crisis du jour and the public realizes the cost involved in curing the initial problem, which might even involve some personal self-sacrifice, the attention fades. People get discouraged, some are threatened by a changing social order, and others get bored with the problem. Twilight ensues, with only occasional flickers of interest.

5. Post-Problem Stage

Picture seeing the hygienist at the six-month interval. The week before the appointment, try restarting flossing/water picking. Getting on the scale for an annual physician’s visit could prompt a crash diet which is usually unsuccessful.

Once the curtain closes on the main event, the show may not be completely over. Of course, a recurrence of the inciting event brings back attention; some of the previous “fixes” come to the forefront again, but the excitement of the initial time rarely revives. However, a previously notorious problem receives more attention than it would have if it never had the original infamy.

Why Do Some Issues Catch Hold While Others Don’t?   

Catching an individual’s or the public’s attention generally requires three factors.

  1. The personal issue must matter. A dental tragedy or new onset of high blood pressure focuses attention and can cause a change in behavior.With a societal stress, a large percentage of the population must suffer from the calamity. Absolute numbers matter, but the larger population, distracted by their everyday stress, can overlook suffering minorities (not necessarily ethnic minorities). Until an emergency affects most people, life proceeds unchanged — not much happens, while the threat is ignored.
  2. Personally knowing someone with a delayed diagnosis of a dread disease does motivate preventive screening. Tragically, many cancers are diagnosed late thus worsening prognosis.On broader societal issues, powerful or entrenched people need to take interest and lead. Ideally, these leaders have the well-being and health of the overall population in mind while propelling forward a solution. Unfortunately, self-serving or economic interests may dominate, thus benefiting one group or industry while disadvantaging everyone else. One example is public transportation, which the automobile industry stunted for generations. Most people wanted and enjoyed their own cars. Therefore, tax dollars went to build highway, dollars that could have supported public transportation — trains, subways, bus lines, and other more efficient mechanisms.
  3. Finances, access, and health insurance matters as well as media interest. Health status and life expectancy vary greatly across the socioeconomic spectrum.Media coverage surfaces an issue and critical topics stay in the limelight until another interest emerges. Also entertainment, talk shows, and sports may outnumber serious national and international news because advertising revenue is robust with the former stories. Moreover, old news doesn’t sell. For example, once NASA had men walking on the moon, subsequent routine flights did not attract viewers. However, sensationalism and tragedy do draw viewers, as evidenced by NASA’s near disaster of Apollo 13. “If it bleeds, it leads” is an old newspaper maxim.

What Should We Do?

Ultimately, to improve humanity, one needs to keep attention on and actively address long-standing societal problems. Steps include adapting a thoughtful proven approach, dedicating appropriate resources, defining objective metrics, celebrating small wins, avoiding inevitable distractions, and ignoring the “news cycle.”

Healthy behaviors, when persistently followed, create a longer, happier, and healthier life. Distractions occur but people with persistent focus do better than those who delay or avoid. Resources matter, as evidenced by the wide variation among life expectancies across the socioeconomic spectrum. Starting with an awareness of the “attention cycle issue” will avoid distractions and thus facilitate individual and humankind’s soaring aspirations.

Sources

  1. “Opportunities in Crisis and Catastrophe: The Issue-Attention Cycle and Political Reality, by Christopher Kimrey, Homeland Security Affairs, May 2016
  2. “Up and down with ecology—the issue-attention cycle.” Anthony Downs, National Affairs, Summer1972
  3. “Salt, Sugar, Fat: How the Food Industry Hook Us,” Michael Moss, 2013
  4. “Caste: The Origins of Our Discontents,” Isabel Wilkerson, 2020

Read other 4sight Health articles discussing U.S. life expectancy and disparities.

Separate And Unequal, Part 1 and Part 2, David W. Johnson

Scientific Aging: The Genetic Basis for Longer, Healthier Lifespans, David W. Johnson & Leroy Hood, MD, Ph.D.

The Science of Wellness, Leroy Hood, MD, Ph.D

Pandemics Cubed: Social Injustice and Chronic Disease Amplify COVID-19’s Virulence, Allen Weiss, MD

The Next Moonshot: Moving to Reverse America’s Declining Life Expectancy, Allen Weiss, MD

How Long Are You Going To Live? Life Expectancy Is Predictable, Allen Weiss, MD

About the Author

Allen Weiss

Dr. Allen Weiss is Chief Medical Officer for the national Blue Zones Project. Having practiced rheumatology, internal medicine, and geriatrics for 23 years and been President and CEO for 18 years of a 716-bed, two-hospital integrated system, Dr. Weiss now has a national scope focused on prevention. After graduating from Columbia University’s College of Physicians and Surgeons and subsequently completing his training at both the New York Presbyterian Hospital and Hospital for Special Surgery of Cornell University, he had a solo practice in Rheumatology, Internal Medicine, and Geriatrics for twenty-three years. He is recognized both as a Fellow of the American College of Physicians and a Fellow of the American College of Rheumatology. Dr. Weiss’s national commitments and honors include: named as one of the Top 100 outstanding physician leaders of healthcare systems by Becker’s Hospital Review multiple times; chosen as a keynote speaker at numerous meetings; served five years on the Regional Advisory Council of the American Hospital Association; elected to the American Hospital Association Board in 2017; selected as Chairman of the Upper Midwest Vizient Board; and continues as a Director of American Momentum Bank. In 2005, he was invited to testify on information technology before the U.S. House Ways and Means Health Subsection. For the state of Florida, Dr. Weiss is past Chair of the Florida Hospital Association as well as its Quality Committee. The Florida Hospital Association presented Dr. Weiss with its highest award in 2019 for advancing healthcare, and he has received numerous other awards from Florida organizations. His wife, Dr. Marla Weiss, is a writer and educator. They have two daughters who are physicians, one a biomedical illustrator/educator and the other an adolescent medicine physician/educator.

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